Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 8136 | TX |
NPI | 1154544328 |
---|---|
Provider Name | Dr. Matthew Mckay Hicken |
First Address | Ft Worth, TX 76112 |
Second Address | Ft Worth, TX 76112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 26/07/2013 |