Provider Demographics
NPI:1023140969
Name:HICKEL, MICHAEL WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:HICKEL
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 1:8305 SE MONTEREY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7728
Mailing Address - Country:US
Mailing Address - Phone:503-786-7786
Mailing Address - Fax:503-786-7191
Practice Address - Street 1:8305 SE MONTEREY AVE STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-786-7786
Practice Address - Fax:503-786-7191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109040Medicare ID - Type Unspecified