Provider Demographics
NPI:1598999757
Name:HICKMAN, JEFFERY CHARLES (DC, PA-C)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:CHARLES
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:DR
Other - First Name:JEFFERY
Other - Middle Name:CHARLES
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PA-C
Mailing Address - Street 1:3000 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1818
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 81C
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-9501
Practice Address - Country:US
Practice Address - Phone:580-875-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-03
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3926111N00000X
OK1298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No111N00000XChiropractic ProvidersChiropractor