Provider Demographics
NPI:1538266648
Name:LIKENS, LLAIRD L (DC)
Entity type:Individual
Prefix:DR
First Name:LLAIRD
Middle Name:L
Last Name:LIKENS
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 1:1816 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7695
Mailing Address - Country:US
Mailing Address - Phone:850-939-3339
Mailing Address - Fax:850-939-1605
Practice Address - Street 1:1816 ALPINE DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7695
Practice Address - Country:US
Practice Address - Phone:850-939-3339
Practice Address - Fax:850-939-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008916111NI0013X, 111NN1001X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X, 171100000X, 225700000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71910OtherBLUE CROSS BLUE SHIELD
FLLIKENSDCOtherOPTUM
FLT88515Medicare UPIN