Provider Demographics
NPI:1760476816
Name:HICKLIN, CHRISTOPHER LOWE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LOWE
Last Name:HICKLIN
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 1:3220 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8302
Mailing Address - Country:US
Mailing Address - Phone:941-923-4357
Mailing Address - Fax:941-923-9943
Practice Address - Street 1:3220 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8302
Practice Address - Country:US
Practice Address - Phone:941-923-4357
Practice Address - Fax:941-923-9943
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26-1512892OtherTID
FL88736YOtherMEDICARE PTAN
FLT55942Medicare UPIN
FLAY270Medicare PIN