MEDICARE: HICKEY CHIROPRACTIC CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH9005;	FL

General Provider Information

NPI Number	:	1356645824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKEY CHIROPRACTIC CENTER INC.

Provider Business Mailing Address
First Line	:	4300 S JOG RD UNIT 540611
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-5028
Country	:	US
Telephone Number	:	561-603-3454
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 CLEMATIS ST STE 3000
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-4609
Country	:	US
Telephone Number	:	561-603-3454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. LESLIE GRACE HICKEY
Credential	:	DC
Telephone Number	:	561-603-3454

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	09/15/2021

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