Healthcare Provider Details

I. General information

NPI: 1083837603
Provider Name (Legal Business Name): HICKS CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 MCPHERSON RD SUITE 2
LAREDO TX
78041-6182
US

IV. Provider business mailing address

6202 MCPHERSON RD SUITE 2
LAREDO TX
78041-6182
US

V. Phone/Fax

Practice location:
  • Phone: 956-791-8686
  • Fax: 956-791-8687
Mailing address:
  • Phone: 956-791-8686
  • Fax: 956-791-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5560
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5560
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5560
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number5560
License Number StateTX

VIII. Authorized Official

Name: DR. ROLAND RUSSELL HICKS
Title or Position: PRESIDENT
Credential: DC
Phone: 956-791-8686