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General NPI Number Information
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NPI Number | 1073680088
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Entity Type | Organization
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Legal Business Name | BOLICK CLINIC, INC.
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 500 E HORATIO AVE STE 5
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City | MAITLAND
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State | FL
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Zip | 32751-7310
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Country | US
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Telephone | 407-629-5333
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Fax | 407-629-5343
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Provider Business Mailing Address
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Address Line | 500 E HORATIO AVE STE 5
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City | MAITLAND
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State | FL
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Zip | 32751-7310
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Country | US
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Telephone | 407-629-5333
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Fax | 407-629-5343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHANNING C BOLICK
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Credential | DC
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Telephone | 407-629-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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