Provider Demographics
NPI:1629056932
Name:STICKEL, THOMAS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:STICKEL
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 1:11 KRISTIN CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1720
Mailing Address - Country:US
Mailing Address - Phone:850-897-1177
Mailing Address - Fax:850-897-1377
Practice Address - Street 1:4400 E HIGHWAY 20
Practice Address - Street 2:SUITE 207
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8779
Practice Address - Country:US
Practice Address - Phone:850-897-1177
Practice Address - Fax:850-897-1377
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10721913OtherCAQH
FLT20722Medicare UPIN
FL22749Medicare ID - Type UnspecifiedMEDICARE, BCBS