=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679637623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES EDWARD HICKS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 09/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 W MAIN ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24153-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-375-9220
-----------------------------------------------------
Fax | 434-793-9315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 681789
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37068-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-435-0584
-----------------------------------------------------
Fax | 615-435-0549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104557201
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4710
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------