Provider Demographics
NPI:1528061736
Name:KICKLAND, JAMES BRYAN (DC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRYAN
Last Name:KICKLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E. 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1812
Mailing Address - Country:US
Mailing Address - Phone:712-243-5790
Mailing Address - Fax:712-243-3975
Practice Address - Street 1:1101 E. 7TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1812
Practice Address - Country:US
Practice Address - Phone:712-243-5790
Practice Address - Fax:712-243-3975
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1135848Medicaid
IAU36188Medicare UPIN
IA1135848Medicaid
IA06911Medicare ID - Type UnspecifiedMEDICARE