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General NPI Number Information
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NPI Number | 1528087533
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Entity Type | Organization
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Legal Business Name | ATHERTON BACK & NECK CARE CENTER
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1343 N ATHERTON ST
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City | STATE COLLEGE
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State | PA
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Zip | 16803-2932
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Country | US
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Telephone | 814-234-6699
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Fax | 814-234-6899
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Provider Business Mailing Address
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Address Line | 1343 N ATHERTON ST
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City | STATE COLLEGE
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State | PA
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Zip | 16803-2932
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Country | US
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Telephone | 814-234-6699
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Fax | 814-234-6899
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAVID JOHN MIKULA
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Credential | D.C.
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Telephone | 814-234-6699
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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 | DC005374L
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License Number State | PA
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