Provider Demographics
NPI:1548365638
Name:FICKLIN, TOBY ANDREW (DC ATC)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:ANDREW
Last Name:FICKLIN
Suffix:
Gender:M
Credentials:DC ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E SELTICE WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-777-0157
Mailing Address - Fax:208-777-0345
Practice Address - Street 1:601 E SELTICE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-777-0157
Practice Address - Fax:208-777-0345
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC2417OtherBCBS
ID000010035122OtherREGENCE BLUE SHIELD
U87295Medicare UPIN
ID1674737Medicare ID - Type Unspecified