Provider Demographics
NPI:1154544328
Name:HICKEN, MATTHEW MCKAY (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MCKAY
Last Name:HICKEN
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 1:1100 BRIDGEWOOD DR.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112
Mailing Address - Country:US
Mailing Address - Phone:817-727-4690
Mailing Address - Fax:817-727-4695
Practice Address - Street 1:1100 BRIDGEWOOD DR.
Practice Address - Street 2:SUITE 108
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:817-727-4690
Practice Address - Fax:817-727-4695
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8136111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation