Provider Demographics
NPI:1265796551
Name:HICKOX, JOHN BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
Last Name:HICKOX
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 1:2717 WINDEMERE DRIVE SUITE E
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-293-1333
Mailing Address - Fax:229-242-0007
Practice Address - Street 1:2717 WINDEMERE DRIVE SUITE E
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2017
Practice Address - Country:US
Practice Address - Phone:229-293-1333
Practice Address - Fax:229-242-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor