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General NPI Number Information
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NPI Number | 1285805184
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Entity Type | Organization
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Legal Business Name | HICKS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 3050 N NAVAJO DR STE 103
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8663
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Country | US
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Telephone | 928-759-0696
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Fax | 928-759-2022
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Provider Business Mailing Address
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Address Line | 3050 N NAVAJO DR STE 103
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8663
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Country | US
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Telephone | 928-759-0696
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Fax | 928-759-2022
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ANDREW FORREST HICKS
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Credential | D.C.
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Telephone | 928-759-0696
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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 | 7868
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License Number State | AZ
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