Provider Demographics
NPI:1043369630
Name:HICKMAN, ACIE GUY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ACIE
Middle Name:GUY
Last Name:HICKMAN
Suffix:JR
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 1:808 RESERVOIR RD
Mailing Address - Street 2:STE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5707
Mailing Address - Country:US
Mailing Address - Phone:501-221-2111
Mailing Address - Fax:
Practice Address - Street 1:808 RESERVOIR RD
Practice Address - Street 2:STE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5707
Practice Address - Country:US
Practice Address - Phone:501-221-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20551Medicare UPIN
AR59068Medicare ID - Type UnspecifiedARKANSAS BCBS