Provider Demographics
NPI:1376186940
Name:ADVANCED CENTER FOR SPORTS & MUSCULOSKELETAL MEDICINE INC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR SPORTS & MUSCULOSKELETAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-636-1067
Mailing Address - Street 1:665 CAMINO DE LOS MARES STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2841
Mailing Address - Country:US
Mailing Address - Phone:949-388-1060
Mailing Address - Fax:855-523-0512
Practice Address - Street 1:665 CAMINO DE LOS MARES STE 305
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2841
Practice Address - Country:US
Practice Address - Phone:949-388-1060
Practice Address - Fax:855-523-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty