Bolick Clinic, Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BOLICK CLINIC, INC.

Practice address

500 E Horatio Ave Ste 5
Maitland, FL 32751-7310

Phone

(407) 629-5333

Fax

(407) 629-5343

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Channing C Bolick, DCNPI 1316936206

Title

President

Phone

(407) 629-5333

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• The Bolick Clinic Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Channing C Bolick, DC, MS

  • Chiropractor
  • Maitland, FL
  • NPI 1316936206
  Medicare reassignment NPD Authorized official
• Cesar A Euribe, MD

  • Interventional Pain Medicine Physician
  • Ocala, FL
  • NPI 1174517676
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1073680088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E HORATIO AVE STE 5",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517310",
            "telephone_number": "407-629-5333",
            "fax_number": "407-629-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E HORATIO AVE STE 5",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517310",
            "telephone_number": "407-629-5333",
            "fax_number": "407-629-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLICK CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "BOLICK",
        "authorized_official_first_name": "CHANNING",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-629-5333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3819132-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "55996",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Bolick Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Louis C Blumenfeld, MD
• Cassandra Jean Board, APRN
• Kristen Lynn Boccher, RD, LD/N
• Eileen Mary Bohan, OT
• Courtney Bolduc
• Channing C Bolick, DC, MS
• Bridgette Bolshem, MD
• Chrislon Bolton
• Alexia Bombalier
• Victoria Bonelli, MA, LMFT, LMHC, NBCC

• Multi-Specialty Clinic/Center in Maitland, FL
• Providers in Maitland, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.