MEDICARE: DR. PAUL BRYAN HICKMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6162DC	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350054270	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	604059	OTHER	TX	BLUE CROSS BLUE SHIELD
3	5877715	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1386793693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BRYAN HICKMAN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 435
Second Line	:	12633 HIGHWAY 6
City	:	SANTA FE
State	:	TX
Zip	:	77510-0435
Country	:	US
Telephone Number	:	409-925-4588
Fax Number	:	409-925-4588

Provider Business Practice Location Address
First Line	:	12633 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7613
Country	:	US
Telephone Number	:	409-925-4588
Fax Number	:	409-925-4588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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