MEDICARE: DR. DMITRIY V MIKHOL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	36243	CA

General Provider Information

NPI Number	:	1629727425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DMITRIY V MIKHOL DC

Provider Business Mailing Address
First Line	:	2006 FLORIDA ST APT 18
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3298
Country	:	US
Telephone Number	:	201-835-9704
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 FLORIDA ST APT 18
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3298
Country	:	US
Telephone Number	:	201-835-9704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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