Provider Demographics
NPI:1083837603
Name:HICKS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HICKS CHIROPRACTIC, P.C.
Other - Org Name:ONSITE DOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-791-8686
Mailing Address - Street 1:6202 MCPHERSON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6182
Mailing Address - Country:US
Mailing Address - Phone:956-791-8686
Mailing Address - Fax:956-791-8687
Practice Address - Street 1:6202 MCPHERSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6182
Practice Address - Country:US
Practice Address - Phone:956-791-8686
Practice Address - Fax:956-791-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5560111N00000X, 111NN1001X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00280RMedicare ID - Type UnspecifiedMEDICARE GROUP #