| NPI | 1134413834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM B HICKS Owner 502-583-8303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00317) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2012-05-23 |