Provider Demographics
NPI:1881997369
Name:SIKKEMA CHIROPRACTIC PA
Entity type:Organization
Organization Name:SIKKEMA CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SIKKEMA
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:352-787-7499
Mailing Address - Street 1:1000 E NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5348
Mailing Address - Country:US
Mailing Address - Phone:352-787-7499
Mailing Address - Fax:
Practice Address - Street 1:1000 E NORTH BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5348
Practice Address - Country:US
Practice Address - Phone:352-787-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381621400Medicaid
FL70082OtherBLUE CROSS AND BLUE SHIELD
FL21404201OtherCITRUS CARE
FLCH6701OtherSTATE LICENCE FOR DR. JOHN D SIKKEMA D.C.
FL70082OtherBLUE CROSS AND BLUE SHIELD
FL70082Medicare PIN