Healthcare Provider Details

I. General information

NPI: 1306239884
Provider Name (Legal Business Name): CECELIA MIKLES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 25TH ST
VANCOUVER WA
98663-3219
US

IV. Provider business mailing address

200 E 25TH ST
VANCOUVER WA
98663-3219
US

V. Phone/Fax

Practice location:
  • Phone: 360-798-5652
  • Fax: 360-992-9242
Mailing address:
  • Phone: 360-798-5652
  • Fax: 360-992-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60533863
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCH60533863
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: