Healthcare Provider Details

I. General information

NPI: 1578598884
Provider Name (Legal Business Name): RAYMOND M SYKES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 S US HIGHWAY 1
PORT ST LUCIE FL
34952-1434
US

IV. Provider business mailing address

6809 S US HIGHWAY 1
PORT ST LUCIE FL
34952-1434
US

V. Phone/Fax

Practice location:
  • Phone: 772-466-4006
  • Fax: 772-466-4007
Mailing address:
  • Phone: 772-466-4006
  • Fax: 772-466-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4520
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0599568
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: