Healthcare Provider Details

I. General information

NPI: 1679662639
Provider Name (Legal Business Name): JOSEPH A HICKS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 BELVEDERE DR
KOKOMO IN
46901-5690
US

IV. Provider business mailing address

824 BELVEDERE DR
KOKOMO IN
46901-5690
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-2273
  • Fax: 765-457-4170
Mailing address:
  • Phone: 765-457-2273
  • Fax: 765-457-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: