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General NPI Number Information
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NPI Number | 1083782858
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Entity Type | Organization
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Legal Business Name | DR THOMAS J MICKELSEN, P.C.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 37625 ANN ARBOR RD SUITE 111
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City | LIVONIA
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State | MI
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Zip | 48150-2400
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Country | US
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Telephone | 734-462-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 6635 WING LAKE RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-2955
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Country | US
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Telephone | 248-626-1116
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. THOMAS JAMES MICKELSEN
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Credential | D.C.
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Telephone | 734-462-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301007193
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License Number State | MI
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