Provider Demographics
NPI:1629187216
Name:HICKMAN, PATRICK J (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:J
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:312 S BALSAM ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1796
Mailing Address - Country:US
Mailing Address - Phone:509-766-1283
Mailing Address - Fax:509-766-0306
Practice Address - Street 1:312 S. BALSAM ST.
Practice Address - Street 2:STE A
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837
Practice Address - Country:US
Practice Address - Phone:509-766-1283
Practice Address - Fax:509-766-0306
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002107111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB33839Medicare ID - Type UnspecifiedMEDICARE NUMBER