Individual
DR. CHANNING C BOLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, MS
Contact information
Practice address
500 E HORATIO AVE STE 5, MAITLAND, FL 32751-7310
(407) 629-5333
(407) 629-5343
Mailing address
500 E HORATIO AVE STE 5, MAITLAND, FL 32751-7310
(407) 629-5333
(407) 629-5343
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2398
SC
111N00000X
Chiropractor
6191
GA
111N00000X
Chiropractor
Primary
CH7882
FL
111NI0013X
Independent Medical Examiner Chiropractor
CH7882
FL
111NX0100X
Occupational Health Chiropractor
CH7882
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10728811
CAQH NUMBER
—
01
—
1455405
CIGNA PROVIDER NUMBER
FL
05
—
2800039-00
—
FL
01
—
332352
AVMED PROVIDER NUMBER
FL
01
—
350050297
RAILROAD MEDICARE
FL
01
—
4573235
GHI PROVIDER NUMBER
FL
01
—
53988
ASHLINK PIN
FL
01
—
544703
WELLCARE/STAYWELL MEDICARE & MEDICAID
—
01
—
55996
BLUE CROSS NUMBER
FL
01
—
945833
PPNI PROVIDER NUMBER
FL
01
—
CH7882
STATE LICENSE NUMBER
FL
01
—
K1903
MEDICARE GROUP NUMBER
FL
01
—
P10000175970
SUNSHINE STATE
FL
Enumeration date
10/14/2005
Last updated
09/23/2025
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