Provider Demographics
NPI:1568644177
Name:PATRICK J. HICKMAN D.C.P.S.
Entity Type:Organization
Organization Name:PATRICK J. HICKMAN D.C.P.S.
Other - Org Name:HICKMAN CHIROPRACTIC AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-766-1283
Mailing Address - Street 1:312 S BALSAM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1796
Mailing Address - Country:US
Mailing Address - Phone:509-766-1283
Mailing Address - Fax:509-766-0309
Practice Address - Street 1:312 S BALSAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1796
Practice Address - Country:US
Practice Address - Phone:509-766-1283
Practice Address - Fax:509-766-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2107111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA97567OtherDLI
WA2018661Medicaid
WA2018661Medicaid