Provider Demographics
NPI:1235203480
Name:HICKMAN, WILLIAM J (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:HICKMAN
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 1:32 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2544
Mailing Address - Country:US
Mailing Address - Phone:603-623-3801
Mailing Address - Fax:603-623-3820
Practice Address - Street 1:32 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2544
Practice Address - Country:US
Practice Address - Phone:603-623-3801
Practice Address - Fax:603-623-3820
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH093-0352-0183A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99008412Medicaid
NH1518176593OtherGROUP NPI
NH02-0503150OtherTAX ID
NHNH8412Medicare ID - Type Unspecified