Provider Demographics
NPI:1871570671
Name:SICKELS, DANIEL LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEWIS
Last Name:SICKELS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N ORLANDO AVE
Mailing Address - Street 2:#105
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3171
Mailing Address - Country:US
Mailing Address - Phone:321-783-9400
Mailing Address - Fax:321-783-9358
Practice Address - Street 1:503 N ORLANDO AVE
Practice Address - Street 2:#105
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3171
Practice Address - Country:US
Practice Address - Phone:321-783-9400
Practice Address - Fax:321-783-9358
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU71777Medicare UPIN
FLK1539Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER