Provider Demographics
NPI:1114022373
Name:MISHKO, JOHN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:MISHKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE.
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-876-6096
Mailing Address - Fax:360-876-6096
Practice Address - Street 1:1950 POTTERY AVE.
Practice Address - Street 2:SUITE #5
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-876-6096
Practice Address - Fax:360-876-6096
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205258OtherL&I
WAT02225Medicare UPIN
WAG8862583Medicare PIN