Provider Demographics
NPI:1982674008
Name:HICKMAN, JAY RUSSELL (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:RUSSELL
Last Name:HICKMAN
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:HICKMAN CHIROPRACTIC
Mailing Address - Street 2:820 4TH ST NE
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441
Mailing Address - Country:US
Mailing Address - Phone:641-456-2280
Mailing Address - Fax:641-456-2280
Practice Address - Street 1:HICKMAN CHIROPRACTIC
Practice Address - Street 2:820 4TH ST NE
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441
Practice Address - Country:US
Practice Address - Phone:641-456-2280
Practice Address - Fax:641-456-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0422543Medicaid
IA45752OtherWELLMARK
IA0422543Medicaid
IAI8724Medicare PIN