MEDICARE: SUMMIT CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

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

General Provider Information

NPI Number	:	1588905780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	11547 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-5001
Country	:	US
Telephone Number	:	407-203-6745
Fax Number	:	407-442-0521

Provider Business Practice Location Address
First Line	:	11547 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-5001
Country	:	US
Telephone Number	:	407-203-6745
Fax Number	:	407-442-0521

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JAMEE J FIKE
Credential	:	DC
Telephone Number	:	407-203-6745

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	05/05/2018

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