Provider Demographics
NPI:1164450565
Name:HICKS, THERESE GRIFFIN (DC, FIACA)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:GRIFFIN
Last Name:HICKS
Suffix:
Gender:F
Credentials:DC, FIACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2602
Mailing Address - Country:US
Mailing Address - Phone:928-425-3207
Mailing Address - Fax:928-425-3662
Practice Address - Street 1:138 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2602
Practice Address - Country:US
Practice Address - Phone:928-425-3207
Practice Address - Fax:928-425-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3793111N00000X
AZ270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ5501OtherHEALTHNET
AZAZ0086750OtherBLUE CROSS BLUE SHIELD