Healthcare Provider Details

I. General information

NPI: 1396730214
Provider Name (Legal Business Name): HARRY G MIKAZANS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E HILLSBORO BLVD SUITE 104
DEERFIELD BEACH FL
33441-3628
US

IV. Provider business mailing address

1000 E HILLSBORO BLVD SUITE 104
DEERFIELD BEACH FL
33441-3628
US

V. Phone/Fax

Practice location:
  • Phone: 954-363-7494
  • Fax: 954-363-7497
Mailing address:
  • Phone: 954-363-7494
  • Fax: 954-363-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH0006645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: