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General NPI Number Information
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NPI Number | 1275935991
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Entity Type | Organization
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Legal Business Name | SHELLY MYCKA, DC, PC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 2091 POTTSTOWN PIKE
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City | POTTSTOWN
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State | PA
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Zip | 19465-8671
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Country | US
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Telephone | 610-469-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 2091 POTTSTOWN PIKE
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City | POTTSTOWN
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State | PA
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Zip | 19465-8671
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Country | US
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Telephone | 610-469-0700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE MYCKA
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Credential | DC
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Telephone | 610-469-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC006918R
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License Number State | PA
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