Provider Demographics
NPI:1134205487
Name:WELLIKOFF, RONALD J (DC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:WELLIKOFF
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 1:8267 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5403
Mailing Address - Country:US
Mailing Address - Phone:954-577-6161
Mailing Address - Fax:954-577-4447
Practice Address - Street 1:8267 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5403
Practice Address - Country:US
Practice Address - Phone:954-577-6161
Practice Address - Fax:954-577-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89931Medicare ID - Type Unspecified
FLT84729Medicare UPIN