Provider Demographics
NPI:1568486777
Name:VICKERS, EDWARD DEE SR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DEE
Last Name:VICKERS
Suffix:SR
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 1:905 W VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3411
Mailing Address - Country:US
Mailing Address - Phone:863-983-8391
Mailing Address - Fax:863-983-2283
Practice Address - Street 1:905 W VENTURA AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3411
Practice Address - Country:US
Practice Address - Phone:863-983-8391
Practice Address - Fax:863-983-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001488111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89525OtherBLUE CROSS/ BLUE SHIELD
FL380116100Medicaid
FL89525Medicare ID - Type Unspecified
FL380116100Medicaid