Provider Demographics
NPI:1285805184
Name:HICKS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HICKS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-759-0696
Mailing Address - Street 1:3050 N NAVAJO DR
Mailing Address - Street 2:STE 103
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8663
Mailing Address - Country:US
Mailing Address - Phone:928-759-0696
Mailing Address - Fax:928-759-2022
Practice Address - Street 1:3050 N NAVAJO DR
Practice Address - Street 2:STE 103
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8663
Practice Address - Country:US
Practice Address - Phone:928-759-0696
Practice Address - Fax:928-759-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty