Healthcare Provider Details

I. General information

NPI: 1659496537
Provider Name (Legal Business Name): CATHERINE ISABELLE MICKLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 PLUM ST STE. C
VALDOSTA GA
31601-7527
US

IV. Provider business mailing address

1808 PLUM ST STE. C
VALDOSTA GA
31601-7527
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-7711
  • Fax: 229-333-7712
Mailing address:
  • Phone: 229-333-7711
  • Fax: 229-333-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: