Provider Demographics
NPI:1538586623
Name:SICKMEYER, SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:SICKMEYER
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 1:18001 N 79TH AVE STE B45
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8393
Mailing Address - Country:US
Mailing Address - Phone:623-773-9234
Mailing Address - Fax:623-773-9228
Practice Address - Street 1:18001 N 79TH AVE STE B45
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8393
Practice Address - Country:US
Practice Address - Phone:623-773-9234
Practice Address - Fax:623-773-9228
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1427442656OtherNPI FOR BUSINESS