Provider Demographics
NPI:1013274968
Name:A GUY HICKMAN DC PA
Entity Type:Organization
Organization Name:A GUY HICKMAN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-221-2111
Mailing Address - Street 1:808 RESERVOIR RD
Mailing Address - Street 2:STE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5707
Mailing Address - Country:US
Mailing Address - Phone:501-221-2111
Mailing Address - Fax:
Practice Address - Street 1:808 RESERVOIR RD
Practice Address - Street 2:STE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5707
Practice Address - Country:US
Practice Address - Phone:501-221-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59068Medicare PIN
ART20551Medicare UPIN