Provider Demographics
NPI:1093867418
Name:MYCKA, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:MYCKA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 TOWN SQUARE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-1017
Mailing Address - Country:US
Mailing Address - Phone:610-469-0700
Mailing Address - Fax:
Practice Address - Street 1:1106 TOWN SQUARE RD STE 4
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-1017
Practice Address - Country:US
Practice Address - Phone:610-469-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006918R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19005OtherMEDICARE GROUP ID
CAW19005OtherMEDICARE GROUP ID
CAWDC28906AMedicare ID - Type Unspecified