Provider Demographics
NPI:1184662124
Name:MICKEY TRAVIS SIZEMORE
Entity Type:Organization
Organization Name:MICKEY TRAVIS SIZEMORE
Other - Org Name:GREENVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-292-0226
Mailing Address - Street 1:4200 E NORTH ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2437
Mailing Address - Country:US
Mailing Address - Phone:864-292-0226
Mailing Address - Fax:864-268-7022
Practice Address - Street 1:4200 E NORTH ST
Practice Address - Street 2:SUITE 18
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2437
Practice Address - Country:US
Practice Address - Phone:864-292-0226
Practice Address - Fax:864-268-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385786OtherANTHEM BC/BS
VA385786OtherANTHEM BC/BS
VA089902Medicare UPIN