Provider Demographics
NPI:1023446911
Name:ALLAN R SIDORSKY DCPA
Entity type:Organization
Organization Name:ALLAN R SIDORSKY DCPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIDORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-673-2820
Mailing Address - Street 1:339 BEACON POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4414
Mailing Address - Country:US
Mailing Address - Phone:954-673-2820
Mailing Address - Fax:407-253-1470
Practice Address - Street 1:1151 BLACKWOOD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4550
Practice Address - Country:US
Practice Address - Phone:407-205-8847
Practice Address - Fax:407-253-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382215000Medicaid
89523ZMedicare UPIN