Provider Demographics
NPI:1114133931
Name:BRUCE D. MIKOTA,D.C.,P.A.
Entity Type:Organization
Organization Name:BRUCE D. MIKOTA,D.C.,P.A.
Other - Org Name:MIKOTA CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIKOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA CCSP
Authorized Official - Phone:864-489-2444
Mailing Address - Street 1:PO BOX 1825
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29342-1825
Mailing Address - Country:US
Mailing Address - Phone:864-489-2444
Mailing Address - Fax:864-489-6948
Practice Address - Street 1:111 W RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2232
Practice Address - Country:US
Practice Address - Phone:864-489-2444
Practice Address - Fax:864-489-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty