Healthcare Provider Details

I. General information

NPI: 1023446911
Provider Name (Legal Business Name): ALLAN R SIDORSKY DCPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE SUITE 110
OCOEE FL
34761-4550
US

IV. Provider business mailing address

339 BEACON POINTE DR
OCOEE FL
34761-4414
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-8847
  • Fax: 407-253-1470
Mailing address:
  • Phone: 954-673-2820
  • Fax: 407-253-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. ALLAN ROBERT SIDORSKY
Title or Position: OWNER
Credential: D.C.
Phone: 954-673-2820