Provider Demographics
NPI:1801204839
Name:HICKOX CHIROPRACTIC AND MASSAGE,LLC
Entity Type:Organization
Organization Name:HICKOX CHIROPRACTIC AND MASSAGE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HICKOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-293-1333
Mailing Address - Street 1:2717 WINDEMERE DRIVE SUITE E
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-293-1333
Mailing Address - Fax:229-242-0007
Practice Address - Street 1:2717 WINDEMERE DRIVE SUITE E
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-293-1333
Practice Address - Fax:229-242-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty