MEDICARE: SEMINOLE CHIROPRACTIC INJURY & WELLNESS CENTER INC

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	HCC 2141	FL

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	:	1851570220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMINOLE CHIROPRACTIC INJURY & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	10863 PARK BLVD
Second Line	:	SUITE 2
City	:	SEMINOLE
State	:	FL
Zip	:	33772-5423
Country	:	US
Telephone Number	:	727-399-2229
Fax Number	:	727-399-2228

Provider Business Practice Location Address
First Line	:	10863 PARK BLVD
Second Line	:	SUITE 2
City	:	SEMINOLE
State	:	FL
Zip	:	33772-5423
Country	:	US
Telephone Number	:	727-399-2229
Fax Number	:	727-399-2228

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. STEPHEN S NICKSE
Credential	:	DC
Telephone Number	:	727-399-2229

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	06/21/2018

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