Provider Demographics
NPI:1386793693
Name:HICKMAN, PAUL BRYAN (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRYAN
Last Name:HICKMAN
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:PO BOX 435
Mailing Address - Street 2:12633 HIGHWAY 6
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-0435
Mailing Address - Country:US
Mailing Address - Phone:409-925-4588
Mailing Address - Fax:409-925-4588
Practice Address - Street 1:12633 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7613
Practice Address - Country:US
Practice Address - Phone:409-925-4588
Practice Address - Fax:409-925-4588
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6162DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350054270OtherRAILROAD MEDICARE
TX604059OtherBLUE CROSS BLUE SHIELD
TX5877715OtherAETNA