Provider Demographics
NPI:1295947661
Name:HICKEY, BRIAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:HICKEY
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 1:1201 ROAD TO SIX FLAGS ST E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5044
Mailing Address - Country:US
Mailing Address - Phone:817-461-2697
Mailing Address - Fax:817-801-5444
Practice Address - Street 1:1201 ROAD TO SIX FLAGS ST E
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5044
Practice Address - Country:US
Practice Address - Phone:817-461-2697
Practice Address - Fax:817-801-5444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8137111N00000X, 111NI0013X, 111NN1001X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician