Provider Demographics
NPI:1609645977
Name:HICKAM, DEVON (DC)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:HICKAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6447 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9559
Mailing Address - Country:US
Mailing Address - Phone:509-789-0157
Mailing Address - Fax:
Practice Address - Street 1:915 E HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1482
Practice Address - Country:US
Practice Address - Phone:509-413-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61491400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor