Provider Demographics
NPI:1912905662
Name:WYCKOFF, STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WYCKOFF
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 1:3348 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2340
Mailing Address - Country:US
Mailing Address - Phone:727-381-7433
Mailing Address - Fax:727-381-7434
Practice Address - Street 1:3348 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2340
Practice Address - Country:US
Practice Address - Phone:727-381-7433
Practice Address - Fax:727-381-7434
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70128YMedicare ID - Type Unspecified
FLU88767Medicare UPIN