Provider Demographics
NPI:1518176593
Name:HICKMAN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HICKMAN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-623-3801
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH093-0352-0183A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99008412Medicaid
NHNH8412Medicare ID - Type Unspecified
NH=========Medicare UPIN