Provider Demographics
NPI:1396326708
Name:HICKS, SHELBY (DC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MCKENNA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2634
Mailing Address - Country:US
Mailing Address - Phone:864-894-0451
Mailing Address - Fax:
Practice Address - Street 1:1068 N CHURCH ST STE 103
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1639
Practice Address - Country:US
Practice Address - Phone:864-894-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor