Brenton Deshawn Hicks, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2021018729 Issued in MO

Practice address

5563 NW Barry Rd
Kansas City, MO 64154-1408

Phone

(816) 710-6673

Fax

(816) 710-6673

NPI assigned

Sep 28, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, IA2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revive Family Chiropractic, LLC

  • Chiropractor
  • Marion, IA
  • NPI 1528480316
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1558033621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5563 NW BARRY RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641541408",
            "telephone_number": "816-710-6673",
            "fax_number": "816-710-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5563 NW BARRY RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641541408",
            "telephone_number": "816-710-6673",
            "fax_number": "816-710-6673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "BRENTON",
        "middle_name": "DESHAWN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-28",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2021018729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Janelle Hickman
• Dianna Lynn Hickman, M.D.
• Kristin Marie Hickman, NP
• Wendy Hickman, LCSW
• Virgie Hickmon, APRN BC
• Caitlyn Pearl White Hicks
• Deon Hicks
• Gary Hicks Jr., DNP-AGNP
• Hannah E Hicks, LMSW
• Heather Hicks, RRT-CTTS

• Chiropractor in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.