Provider Demographics
NPI:1154824282
Name:SIDNEY, DAVID (CCPA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIDNEY
Suffix:
Gender:M
Credentials:CCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 SILVER STAR RD
Mailing Address - Street 2:STE #2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-290-2900
Mailing Address - Fax:407-992-8735
Practice Address - Street 1:6003 SILVER STAR RD
Practice Address - Street 2:STE #2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808
Practice Address - Country:US
Practice Address - Phone:407-290-2900
Practice Address - Fax:407-992-3587
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCI808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor