Provider Demographics
NPI:1194003483
Name:HICKEN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HICKEN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-537-5500
Mailing Address - Street 1:512 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1924
Mailing Address - Country:US
Mailing Address - Phone:308-537-5500
Mailing Address - Fax:308-537-5502
Practice Address - Street 1:512 10TH ST
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1924
Practice Address - Country:US
Practice Address - Phone:308-537-5500
Practice Address - Fax:308-537-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026063400Medicaid