Healthcare Provider Details

I. General information

NPI: 1699923946
Provider Name (Legal Business Name): MICKO CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 E 4TH AVE SUITE 101
MILBANK SD
57252-1543
US

IV. Provider business mailing address

1203 E 4TH AVE SUITE 101
MILBANK SD
57252-1543
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-9561
  • Fax: 605-432-9562
Mailing address:
  • Phone: 605-432-9561
  • Fax: 605-432-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1120
License Number StateSD

VIII. Authorized Official

Name: AARON MICKO
Title or Position: CHIROPRACTOR
Credential:
Phone: 605-432-9561