Provider Demographics
NPI:1356417356
Name:ROBERT A VICKERS DC PA HIGHLANDS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ROBERT A VICKERS DC PA HIGHLANDS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEI
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-382-8804
Mailing Address - Street 1:721 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2169
Mailing Address - Country:US
Mailing Address - Phone:863-382-8804
Mailing Address - Fax:863-382-8401
Practice Address - Street 1:721 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2169
Practice Address - Country:US
Practice Address - Phone:863-382-8804
Practice Address - Fax:863-382-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70728OtherBLUE CROSS BLUE SHIELD
FL70728Medicare ID - Type Unspecified
FL70728OtherBLUE CROSS BLUE SHIELD