Provider Demographics
NPI:1013195858
Name:NICOLE S. MIKLOS, D.C., INC.
Entity Type:Organization
Organization Name:NICOLE S. MIKLOS, D.C., INC.
Other - Org Name:DBA CHIROPRACTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIKLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-220-4242
Mailing Address - Street 1:50 PEARL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5700
Mailing Address - Country:US
Mailing Address - Phone:330-220-4242
Mailing Address - Fax:330-220-9798
Practice Address - Street 1:50 PEARL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-5700
Practice Address - Country:US
Practice Address - Phone:330-220-4242
Practice Address - Fax:330-220-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU79308Medicare UPIN