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General NPI Number Information
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NPI Number | 1942429691
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE HICKS D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 654 BROADMOOR DR
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3163
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Country | US
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Telephone | 314-374-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 3394 MCKELVEY RD SUITE 114
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City | BRIDGETON
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State | MO
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Zip | 63044-2531
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Country | US
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Telephone | 314-374-9399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2007007207
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License Number State | MO
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