Provider Demographics
NPI:1740798198
Name:HICKS, JEANNIE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:MARIE
Last Name:HICKS
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 1:1250 BELVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-8736
Mailing Address - Country:US
Mailing Address - Phone:337-208-9220
Mailing Address - Fax:
Practice Address - Street 1:908 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4614
Practice Address - Country:US
Practice Address - Phone:337-404-4084
Practice Address - Fax:337-392-2580
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA82-3415188OtherBCBS