Provider Demographics
NPI:1558912030
Name:HICKMAN, MORGAN JEAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:JEAN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2831
Mailing Address - Country:US
Mailing Address - Phone:217-855-5710
Mailing Address - Fax:
Practice Address - Street 1:211 S QUINCY ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-1953
Practice Address - Country:US
Practice Address - Phone:217-935-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor