MEDICARE: DR. MICHELLE MYCKA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC006918R	PA

General Provider Information

NPI Number	:	1093867418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MYCKA DC

Provider Business Mailing Address
First Line	:	1106 TOWN SQUARE RD
Second Line	:	STE 4
City	:	POTTSTOWN
State	:	PA
Zip	:	19465-1017
Country	:	US
Telephone Number	:	610-469-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 TOWN SQUARE RD STE 4
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19465-1017
Country	:	US
Telephone Number	:	610-469-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	04/02/2019

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