Provider Demographics
NPI:1114486131
Name:HICKMAN, JENNIFER JONES (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JONES
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:TIFFANY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:145 DUNES DR
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-9400
Mailing Address - Country:US
Mailing Address - Phone:704-476-0012
Mailing Address - Fax:
Practice Address - Street 1:145 DUNES DR
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-9400
Practice Address - Country:US
Practice Address - Phone:704-476-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4275111N00000X
NC4743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor