Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 036149231 | IL |
Y | 213ES0000X | Sports Medicine | 036149231 | IL |
NPI | 1093120545 |
---|---|
Provider Name | Dr. Christopher Hicks |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 26/07/2019 |