Provider Demographics
NPI:1639487861
Name:HICKMAN, SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16832 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2112
Mailing Address - Country:US
Mailing Address - Phone:281-480-7000
Mailing Address - Fax:281-480-7017
Practice Address - Street 1:305 FM 517 RD E
Practice Address - Street 2:STE A
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8630
Practice Address - Country:US
Practice Address - Phone:281-889-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor