Provider Demographics
NPI:1366567091
Name:RONALD R HICKS DC INC PC
Entity type:Organization
Organization Name:RONALD R HICKS DC INC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DC
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-341-6535
Mailing Address - Street 1:900 EAST WILL ROGERS BLVD
Mailing Address - Street 2:CLAREMORE CHIROPRACTIC RONALD R HICKS DC INC PC
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017
Mailing Address - Country:US
Mailing Address - Phone:918-341-6535
Mailing Address - Fax:918-341-6566
Practice Address - Street 1:900 EAST WILL ROGERS
Practice Address - Street 2:SUITE D
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-341-6535
Practice Address - Fax:918-341-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75193Medicare UPIN