Provider Demographics
NPI:1114925328
Name:HICKS, CHRISTOPHER KIP (CPO/LPO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KIP
Last Name:HICKS
Suffix:
Gender:M
Credentials:CPO/LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4333
Mailing Address - Country:US
Mailing Address - Phone:256-539-7997
Mailing Address - Fax:256-539-7991
Practice Address - Street 1:909 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4333
Practice Address - Country:US
Practice Address - Phone:256-539-7997
Practice Address - Fax:256-539-7991
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-09-17
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
DECPO 024371744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148605Medicaid
753014671OtherFEDERAL TAX ID #
TN1454203Medicaid