Provider Demographics
NPI:1689606519
Name:HICKMAN, WALTER (DC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:HICKMAN
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 1:17920 HUFFMEISTER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3793
Mailing Address - Country:US
Mailing Address - Phone:281-256-0606
Mailing Address - Fax:281-256-0659
Practice Address - Street 1:17920 HUFFMEISTER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3793
Practice Address - Country:US
Practice Address - Phone:281-256-0606
Practice Address - Fax:281-256-0659
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor