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General NPI Number Information
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NPI Number | 1134281322
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Entity Type | Organization
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Legal Business Name | MIKLOS CENTER FOR HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 4550 LIBERTY AVE SUITE 100
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City | VERMILION
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State | OH
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Zip | 44089-1910
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Country | US
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Telephone | 440-967-5545
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Fax | 440-967-5546
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Provider Business Mailing Address
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Address Line | PO BOX 413
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City | VERMILION
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State | OH
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Zip | 44089-0413
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Country | US
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Telephone | 440-967-5545
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Fax | 440-967-5546
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL DAVID MIKLOS
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Credential | DC
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Telephone | 440-967-5545
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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 | 3273
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License Number State | OH
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