Healthcare Provider Details

I. General information

NPI: 1164450565
Provider Name (Legal Business Name): THERESE GRIFFIN HICKS D.C., F.I.A.C.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S BROAD ST
GLOBE AZ
85501-2602
US

IV. Provider business mailing address

138 S BROAD ST
GLOBE AZ
85501-2602
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3207
  • Fax: 928-425-3662
Mailing address:
  • Phone: 928-425-3207
  • Fax: 928-425-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3793
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number270
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: