Provider Demographics
NPI:1386024743
Name:SIKES, SHANE E (DC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:E
Last Name:SIKES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 SE 17 ST
Mailing Address - Street 2:LAKE CITY SPINE & INJURY
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:386-754-2821
Mailing Address - Fax:386-438-5787
Practice Address - Street 1:809 CR 466
Practice Address - Street 2:C-301
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3215
Practice Address - Country:US
Practice Address - Phone:352-732-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor