Provider Demographics
NPI:1972536852
Name:HICKS, TONY L (DC)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:L
Last Name:HICKS
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:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008
Mailing Address - Country:US
Mailing Address - Phone:918-366-7100
Mailing Address - Fax:918-366-7101
Practice Address - Street 1:5085 EAST 151ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4421
Practice Address - Country:US
Practice Address - Phone:918-366-7100
Practice Address - Fax:918-366-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU61723Medicare UPIN