Active NPI
Brent Hicks
- Rehabilitation Chiropractor
- Michigan City, IN
National Provider Identifier
1073656534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 08001324A
- Practice address
- 501 W Kieffer Rd # 400N
Michigan City, IN 46360-9580 - Phone
- (219) 879-2177
- NPI assigned
- Feb 15, 2007
- Last updated
- Sep 30, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 08001324A | IN | Primary |
Addresses
Primary practice location
501 W Kieffer Rd # 400N
Michigan City, IN 46360-9580
Mailing address
501 W Kieffer Rd # 400N
Michigan City, IN 46360-9580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200431860A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317340800000",
"number": "1073656534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 W KIEFFER RD # 400N",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463609580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W KIEFFER RD # 400N",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463609580",
"telephone_number": "219-879-2177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "BRENT",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2011-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "IN",
"license": "08001324A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200431860A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.