Individual
DR. BRENT HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 W KIEFFER RD # 400N, MICHIGAN CITY, IN 46360-9580
(219) 879-2177
Mailing address
501 W KIEFFER RD # 400N, MICHIGAN CITY, IN 46360-9580
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
08001324A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200431860A
—
IN
Enumeration date
02/15/2007
Last updated
09/30/2011
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