Provider Demographics
NPI:1730125436
Name:HICKS, JAMES A (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
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 1:815 PYLE DRIVE
Mailing Address - Street 2:FAMILY CHIROPRACTIC CLINIC PC
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802
Mailing Address - Country:US
Mailing Address - Phone:906-774-4911
Mailing Address - Fax:906-776-1778
Practice Address - Street 1:815 PYLE DRIVE
Practice Address - Street 2:FAMILY CHIROPRACTIC CLINIC PC
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802
Practice Address - Country:US
Practice Address - Phone:906-774-4911
Practice Address - Fax:906-776-1778
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350038463Medicare PIN
MIMI5158004Medicare PIN
0M23280Medicare PIN
MIMI5158Medicare PIN
U60154Medicare UPIN