Provider Demographics
NPI:1972977668
Name:HICKEY, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HELENDALE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3173
Mailing Address - Country:US
Mailing Address - Phone:585-654-6670
Mailing Address - Fax:
Practice Address - Street 1:500 HELENDALE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:585-654-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY012754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program