Provider Demographics
NPI:1851521827
Name:HICKS, JUANITA (DC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
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 1:4800 LAMONTE LN
Mailing Address - Street 2:APT. 3809
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5434
Mailing Address - Country:US
Mailing Address - Phone:832-725-5485
Mailing Address - Fax:
Practice Address - Street 1:1770 SAINT JAMES PL
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3471
Practice Address - Country:US
Practice Address - Phone:713-622-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor