Provider Demographics
NPI:1356645824
Name:HICKEY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:HICKEY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-603-3454
Mailing Address - Street 1:4300 S JOG RD UNIT 540611
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-5028
Mailing Address - Country:US
Mailing Address - Phone:561-603-3454
Mailing Address - Fax:
Practice Address - Street 1:301 CLEMATIS ST STE 3000
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4609
Practice Address - Country:US
Practice Address - Phone:561-603-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9005;111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty