Provider Demographics
NPI:1922524610
Name:HICKS, JOSEPH LYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LYLE
Last Name:HICKS
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 1:605 BELLEAIR PL
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2611
Mailing Address - Country:US
Mailing Address - Phone:727-259-5305
Mailing Address - Fax:
Practice Address - Street 1:605 BELLEAIR PL
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2611
Practice Address - Country:US
Practice Address - Phone:727-259-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor