Provider Demographics
NPI:1679662639
Name:HICKS, JOSEPH A (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
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 1:824 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5690
Mailing Address - Country:US
Mailing Address - Phone:765-457-2273
Mailing Address - Fax:765-457-4170
Practice Address - Street 1:824 BELVEDERE DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5690
Practice Address - Country:US
Practice Address - Phone:765-457-2273
Practice Address - Fax:765-457-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002090A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU97647Medicare UPIN
IN213290Medicare ID - Type Unspecified