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NPI Code Detail

MEDICARE: DR. MICAELA SUE DOLEZAL D.C.

MEDICARE:  DR. MICAELA SUE DOLEZAL  D.C.
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
1111N00000XChiropractor06658IA
2111N00000XChiropractor038-010052IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225058704
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICAELA SUE DOLEZAL D.C.
Provider Business Mailing Address
First Line : 3100 CEDAR CREST RDG
Second Line : SUITE 4
City : DUBUQUE
State : IA
Zip : 52003-6700
Country : US
Telephone Number : 563-557-3040
Fax Number : 563-557-3048
Provider Business Practice Location Address
First Line : 3100 CEDAR CREST RDG
Second Line : SUITE 4
City : DUBUQUE
State : IA
Zip : 52003-6700
Country : US
Telephone Number : 563-557-3040
Fax Number : 563-557-3048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 10/03/2008

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Directions to “ DR. MICAELA SUE DOLEZAL D.C.” Practice Location

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