Provider Demographics
NPI:1033414685
Name:STICE, KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:STICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SCURRY STE. C
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-606-5140
Mailing Address - Fax:432-606-5141
Practice Address - Street 1:500 NORTH CARROLL AVENUE
Practice Address - Street 2:#100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6410
Practice Address - Country:US
Practice Address - Phone:817-488-6495
Practice Address - Fax:817-488-6592
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor