Provider Demographics
NPI:1437408168
Name:HICKEY, SARAH NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MAIN PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1170
Mailing Address - Country:US
Mailing Address - Phone:314-277-4858
Mailing Address - Fax:
Practice Address - Street 1:1023 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1170
Practice Address - Country:US
Practice Address - Phone:314-277-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012030947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor