Provider Demographics
NPI:1851580302
Name:HICKS CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:HICKS CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-525-7855
Mailing Address - Street 1:27537 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2253
Mailing Address - Country:US
Mailing Address - Phone:734-525-7855
Mailing Address - Fax:734-525-0080
Practice Address - Street 1:27537 WARREN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2253
Practice Address - Country:US
Practice Address - Phone:734-525-7855
Practice Address - Fax:734-525-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q25095Medicare PIN