Healthcare Provider Details

I. General information

NPI: 1679637623
Provider Name (Legal Business Name): JAMES EDWARD HICKS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 W MAIN ST
SALEM VA
24153-3120
US

IV. Provider business mailing address

PO BOX 681789
FRANKLIN TN
37068-1789
US

V. Phone/Fax

Practice location:
  • Phone: 540-375-9220
  • Fax: 434-793-9315
Mailing address:
  • Phone: 615-435-0584
  • Fax: 615-435-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557201
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: