Provider Demographics
NPI:1124032966
Name:HICKS, DAVID MOORE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MOORE
Last Name:HICKS
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 1:121 N WASHINGTON ST STE 300A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3174
Mailing Address - Country:US
Mailing Address - Phone:703-299-4600
Mailing Address - Fax:703-299-4660
Practice Address - Street 1:121 N WASHINGTON ST STE 300A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3174
Practice Address - Country:US
Practice Address - Phone:703-299-4600
Practice Address - Fax:703-299-4660
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492170Medicare PIN