MEDICARE: CHAD RONALD HICKEY D.C.

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	23001007497	MI

General Provider Information

NPI Number	:	1457314619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD RONALD HICKEY D.C.

Provider Business Mailing Address
First Line	:	7857 VELTE RD
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-9497
Country	:	US
Telephone Number	:	616-374-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	7857 VELTE RD
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-9497
Country	:	US
Telephone Number	:	616-374-7880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	10/07/2011

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