Provider Demographics
NPI:1497771513
Name:SIDORSKY, ALLAN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:ROBERT
Last Name:SIDORSKY
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 1:339 BEACON POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4414
Mailing Address - Country:US
Mailing Address - Phone:321-234-8900
Mailing Address - Fax:
Practice Address - Street 1:1151 BLACKWOOD AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4550
Practice Address - Country:US
Practice Address - Phone:321-234-8900
Practice Address - Fax:407-930-3544
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89523OtherBCBS FLORIDA
FL3822150 00Medicaid
FLU99889Medicare UPIN
FL89523OtherBCBS FLORIDA