Provider Demographics
NPI:1194885111
Name:SIZEMORE, MICKEY TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:TRAVIS
Last Name:SIZEMORE
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 1:1241 CLINGMAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0083
Mailing Address - Country:US
Mailing Address - Phone:843-295-2998
Mailing Address - Fax:
Practice Address - Street 1:4200 E NORTH ST
Practice Address - Street 2:SUITE 18
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2437
Practice Address - Country:US
Practice Address - Phone:864-292-0226
Practice Address - Fax:864-268-7022
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010432111N00000X
SC3595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385786OtherANTHEM BCBS
VA385786OtherANTHEM BCBS
VA350001247Medicare PIN