Provider Demographics
NPI:1467489245
Name:VICKERS CHIROPRACTIC HEALTH CENTERS PA
Entity Type:Organization
Organization Name:VICKERS CHIROPRACTIC HEALTH CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:863-453-0684
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33826-0150
Mailing Address - Country:US
Mailing Address - Phone:863-453-0684
Mailing Address - Fax:863-453-2873
Practice Address - Street 1:1116 BILLY MARTIN RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-4858
Practice Address - Country:US
Practice Address - Phone:863-453-0684
Practice Address - Fax:863-453-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380135700Medicaid
FL380135700Medicaid
FLQ0034Medicare PIN