Healthcare Provider Details

I. General information

NPI: 1770729097
Provider Name (Legal Business Name): MIKULA CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4056 PLAINFIELD AVE NE SUITE E
GRAND RAPIDS MI
49525-1630
US

IV. Provider business mailing address

4056 PLAINFIELD AVE NE SUITE E
GRAND RAPIDS MI
49525-1630
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-0255
  • Fax: 616-365-0975
Mailing address:
  • Phone: 616-365-0255
  • Fax: 616-365-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007184
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007183
License Number StateMI

VIII. Authorized Official

Name: MRS. CHERYL A. MERKLER
Title or Position: BILLING ASSOCIATE
Credential:
Phone: 616-365-0255