Healthcare Provider Details

I. General information

NPI: 1760992267
Provider Name (Legal Business Name): LEONARD JOSEPH HICKS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 E LELAND CIR
MESA AZ
85207-2034
US

IV. Provider business mailing address

7547 E LELAND CIR
MESA AZ
85207-2034
US

V. Phone/Fax

Practice location:
  • Phone: 520-380-8445
  • Fax:
Mailing address:
  • Phone: 520-380-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP-4272
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17838
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-012198
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: