BOLICK CLINIC INC. NPI 1073680088

NPI Information

  • NPI: 1073680088
  • Provider Name: BOLICK CLINIC, INC.
  • Classification: Clinic/Center - 261QM1300X
  • Specialization: Multi-Specialty
  • Entity Type: Organization
  • CLIA Number: 10D0273769
  • Address: 500 E HORATIO AVE STE 5
    MAITLAND, FL
    ZIP 32751
  • Phone: (407) 629-5333

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NPI Details

BOLICK CLINIC, INC. is a multi-specialty clinic center in Maitland, FL. BOLICK CLINIC, INC. NPI is 1073680088. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

500 E HORATIO AVE STE 5
MAITLAND, FL
ZIP 32751-310
Phone: (407) 629-5333
Fax: (407) 629-5343

The provider's authorized official is Channing C Bolick .
The authorized official title is President and has the following contact phone number (407) 629-5333.

The CLIA number assigned to this NPI record is 10D0273769 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 9/23/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractorNo
2171100000XAcupuncturistNo
3261QM1300XClinic/CenterMulti-SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13819132-00MEDICAIDFLORIDA
255996OTHERFLORIDABLUE CROSS GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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