Provider Demographics
NPI:1396704250
Name:LICHTER, WILLIAM I (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:I
Last Name:LICHTER
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 1:2936 LANDMARK WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-5018
Mailing Address - Country:US
Mailing Address - Phone:727-787-1031
Mailing Address - Fax:813-885-6874
Practice Address - Street 1:8730 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2802
Practice Address - Country:US
Practice Address - Phone:813-885-6001
Practice Address - Fax:813-885-6874
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380716900Medicaid
FL59-3490125OtherFEDERAL TAX ID NUMBER
FL380716900Medicaid
FLU10287Medicare UPIN