Provider Demographics
NPI:1053104067
Name:HICKAM, BRYAN RUSSELL (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:RUSSELL
Last Name:HICKAM
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 1:8757 JACKRABBIT LN STE A
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8994
Mailing Address - Country:US
Mailing Address - Phone:406-388-9915
Mailing Address - Fax:
Practice Address - Street 1:2405 W MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3978
Practice Address - Country:US
Practice Address - Phone:406-219-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-9409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor