Provider Demographics
NPI:1417228768
Name:HICKORY CREEK REHAB AND CHIROPRACTIC
Entity Type:Organization
Organization Name:HICKORY CREEK REHAB AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:MAIRENA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-306-9640
Mailing Address - Street 1:3630 FM 2181
Mailing Address - Street 2:120
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7646
Mailing Address - Country:US
Mailing Address - Phone:940-497-7246
Mailing Address - Fax:
Practice Address - Street 1:3630 FM 2181
Practice Address - Street 2:120
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7646
Practice Address - Country:US
Practice Address - Phone:940-497-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972808533Medicare UPIN