Provider Demographics
NPI:1679637623
Name:HICKS, JAMES EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:HICKS
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:PO BOX 681789
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1789
Mailing Address - Country:US
Mailing Address - Phone:615-435-0584
Mailing Address - Fax:615-435-0549
Practice Address - Street 1:1461 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3120
Practice Address - Country:US
Practice Address - Phone:540-375-9220
Practice Address - Fax:434-793-9315
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557201111N00000X
NC4710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH52222642800OtherBWC NUMBER
OH0261103Medicaid
OH000000204939OtherANTHEM BLUE CROSS BLUE SH
OH522226428OtherTAX I.D.
OH522226428027OtherCARESOURCE
OHHI0804123Medicare ID - Type Unspecified
OH000000204939OtherANTHEM BLUE CROSS BLUE SH