Provider Demographics
NPI:1154501435
Name:OLD BONECRUSHER, INC.
Entity Type:Organization
Organization Name:OLD BONECRUSHER, INC.
Other - Org Name:JANET M. SIKORA AMENDOLA, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIKORA AMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-723-1415
Mailing Address - Street 1:621 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4723
Mailing Address - Country:US
Mailing Address - Phone:321-723-1415
Mailing Address - Fax:
Practice Address - Street 1:621 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4723
Practice Address - Country:US
Practice Address - Phone:321-723-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55480ZMedicare PIN