MEDICARE: BOLICK CLINIC, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	171100000X	Acupuncturist
3	261QM1300X	Multi-Specialty Clinic/Center

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
2	55996	OTHER	FL	BLUE CROSS GROUP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073680088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLICK CLINIC, INC.

Provider Business Mailing Address
First Line	:	500 E HORATIO AVE STE 5
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7310
Country	:	US
Telephone Number	:	407-629-5333
Fax Number	:	407-629-5343

Provider Business Practice Location Address
First Line	:	500 E HORATIO AVE STE 5
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7310
Country	:	US
Telephone Number	:	407-629-5333
Fax Number	:	407-629-5343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHANNING C BOLICK
Credential	:	DC
Telephone Number	:	407-629-5333

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	09/23/2025

Similar Medicare Providers

1316936206 — DR. CHANNING C BOLICK DC, MS
Practice Location Address:

500 E HORATIO AVE STE 5
MAITLAND, FL
32751-7310

Practice Phone: 407-629-5333
Practice Fax: 407-629-5343

1265727861 — CENTRAL FLORIDA INTEGRATED WELLNESS CLINIC PLLC
Practice Location Address:

500 E HORATIO AVE , SUITE 5
MAITLAND, FL
32751-7310

Practice Phone: 407-629-5333
Practice Fax: 407-629-5343

1093594426 — ANURADHA TRIVEDI
Practice Location Address:

601 S LAKE DESTINY RD STE 350
MAITLAND, FL
32751-7222

Practice Phone: 407-647-6555
Practice Fax:

1801749270 — RACHEL CREAMER
Practice Location Address:

341 N MAITLAND AVE
MAITLAND, FL
32751-4783

Practice Phone: 407-756-2084
Practice Fax:

1437151313 — DR. JOHN WEST VAN WERT MD
Practice Location Address:

531 N MAITLAND AVE
MAITLAND, FL
32751-4421

Practice Phone: 321-397-1212
Practice Fax: 321-397-1213

1174366470 — LETICIA CHRISTIE PMHNP-BC
Practice Location Address:

100 E SYBELIA AVE STE 150
MAITLAND, FL
32751-4773

Practice Phone: 407-986-7442
Practice Fax: 407-790-7098

Directions to “BOLICK CLINIC, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.