Provider Demographics
NPI:1962597955
Name:HICKEN, TIFFANY ANN (DC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:HICKEN
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 1:706 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-4529
Mailing Address - Country:US
Mailing Address - Phone:308-389-4909
Mailing Address - Fax:308-382-9398
Practice Address - Street 1:706 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4529
Practice Address - Country:US
Practice Address - Phone:308-382-7470
Practice Address - Fax:308-382-9398
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076250613Medicaid
NE47076250613Medicaid
NE274991Medicare ID - Type Unspecified