Healthcare Provider Details

I. General information

NPI: 1992895106
Provider Name (Legal Business Name): KOKOMO CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number08002090A
License Number StateIN

VIII. Authorized Official

Name: DR. JOSEPH A HICKS
Title or Position: DC
Credential: DC
Phone: 765-457-2273