Provider Demographics
NPI:1063522159
Name:HICKORY MEDICAL CORPORATION, S.C.
Entity type:Organization
Organization Name:HICKORY MEDICAL CORPORATION, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-430-9999
Mailing Address - Street 1:9100 S ROBERTS ROAD
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457
Mailing Address - Country:US
Mailing Address - Phone:708-430-9999
Mailing Address - Fax:708-430-9057
Practice Address - Street 1:9100 S ROBERTS ROAD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457
Practice Address - Country:US
Practice Address - Phone:708-430-9999
Practice Address - Fax:708-430-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31623170OtherBCBS
IL31623170OtherBCBS