Provider Demographics
NPI:1528064979
Name:HANKS, RICKY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEE
Last Name:HANKS
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 1:11411 E NORTHWEST HWY
Mailing Address - Street 2:STE 107
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1442
Mailing Address - Country:US
Mailing Address - Phone:214-343-2225
Mailing Address - Fax:214-343-2655
Practice Address - Street 1:11411 E NORTHWEST HWY
Practice Address - Street 2:STE 107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-1442
Practice Address - Country:US
Practice Address - Phone:214-343-2225
Practice Address - Fax:214-343-2655
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-08-02
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TX4451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002087701Medicaid
TX609280Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX026199Medicare UPIN