Provider Demographics
NPI:1699968479
Name:HICKMAN, BRANDI MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:MICHELLE
Last Name:HICKMAN
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 1:601 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5211
Mailing Address - Country:US
Mailing Address - Phone:937-879-4262
Mailing Address - Fax:937-879-4250
Practice Address - Street 1:601 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5211
Practice Address - Country:US
Practice Address - Phone:937-879-4262
Practice Address - Fax:937-879-4250
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor