=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518176593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HICKMAN CHIROPRACTIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 03/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 WEBSTER ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-623-3801
-----------------------------------------------------
Fax | 603-623-3820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 WEBSTER ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-623-3801
-----------------------------------------------------
Fax | 603-623-3820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM J HICKMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-623-3801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 093-0352-0183A
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------