Healthcare Provider Details

I. General information

NPI: 1467489245
Provider Name (Legal Business Name): VICKERS CHIROPRACTIC HEALTH CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 BILLY MARTIN RD
AVON PARK FL
33825-4858
US

IV. Provider business mailing address

PO BOX 150
AVON PARK FL
33826-0150
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-0684
  • Fax: 863-453-2873
Mailing address:
  • Phone: 863-453-0684
  • Fax: 863-453-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD DEE VICKERS JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 863-453-0684