Provider Demographics
NPI:1902024235
Name:CORY L HICKS DC INC PC
Entity Type:Organization
Organization Name:CORY L HICKS DC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-341-6535
Mailing Address - Street 1:900 E WILL ROGERS BLVD
Mailing Address - Street 2:STE. D
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6303
Mailing Address - Country:US
Mailing Address - Phone:918-341-6535
Mailing Address - Fax:918-341-6566
Practice Address - Street 1:900 E WILL ROGERS BLVD
Practice Address - Street 2:STE. D
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6303
Practice Address - Country:US
Practice Address - Phone:918-341-6535
Practice Address - Fax:918-341-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522444Medicare ID - Type Unspecified