Provider Demographics
NPI:1205997798
Name:HICKS, RYAN EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:HICKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:290 S ALMA SCHOOL RD
Mailing Address - Street 2:#5-7
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7632
Mailing Address - Country:US
Mailing Address - Phone:480-857-1991
Mailing Address - Fax:480-857-2036
Practice Address - Street 1:290 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 5-7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7632
Practice Address - Country:US
Practice Address - Phone:480-857-1991
Practice Address - Fax:480-857-2036
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7728111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist