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General NPI Number Information
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NPI Number | 1255487476
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Entity Type | Organization
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Legal Business Name | KARLA HICKS CORPORATION
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 2610 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46615-2724
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Country | US
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Telephone | 574-232-3000
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Fax | 574-236-4409
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Provider Business Mailing Address
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Address Line | 2610 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46615-2724
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Country | US
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Telephone | 574-232-3000
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Fax | 574-236-4409
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARLA K HICKS
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Credential |
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Telephone | 574-232-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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