Provider Demographics
NPI:1386102242
Name:HICKS, TYLER EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:EDWARD
Last Name:HICKS
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 1:13924 CANTRELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1518
Mailing Address - Country:US
Mailing Address - Phone:501-916-2585
Mailing Address - Fax:501-916-2467
Practice Address - Street 1:13924 CANTRELL RD STE C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1518
Practice Address - Country:US
Practice Address - Phone:501-916-2585
Practice Address - Fax:501-916-2467
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART16219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR264603718Medicaid