MEDICARE: CHARLES VICKERS DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0003329	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245241553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES VICKERS DC PA

Provider Business Mailing Address
First Line	:	4325 HIGHLAND PARK BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1671
Country	:	US
Telephone Number	:	863-644-5541
Fax Number	:	863-647-1793

Provider Business Practice Location Address
First Line	:	4325 HIGHLAND PARK BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1671
Country	:	US
Telephone Number	:	863-644-5541
Fax Number	:	863-647-1793

Authorized Official
Title or Position	:	CHIROPRACTOR CLINIC DIRECTOR
Name	:	DR. CHARLES ROBERT VICKERS
Credential	:	DC
Telephone Number	:	863-644-5541

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/17/2008

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Directions to “CHARLES VICKERS DC PA ” Practice Location

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