Individual
DR. THOMAS DENNIS HICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
376 S LATAH ST, BOISE, ID 83705-1539
(208) 338-9111
Mailing address
376 S LATAH ST, BOISE, ID 83705-1539
(208) 338-9111
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
CHIA-473
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147245
BLUE SHIELD
ID
01
—
C473-6
BLUE CROSS
ID
Enumeration date
11/02/2006
Last updated
07/09/2007
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