Provider Demographics
NPI:1124020896
Name:MIELKE, RAYMOND W (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:W
Last Name:MIELKE
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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:NEW RICHLAND
Mailing Address - State:MN
Mailing Address - Zip Code:56072-0441
Mailing Address - Country:US
Mailing Address - Phone:507-463-3811
Mailing Address - Fax:507-463-3812
Practice Address - Street 1:131 BROADWAY AVE SO
Practice Address - Street 2:
Practice Address - City:NEW RICHLAND
Practice Address - State:MN
Practice Address - Zip Code:56072
Practice Address - Country:US
Practice Address - Phone:507-463-3811
Practice Address - Fax:507-463-3812
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1496111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K036GROtherBCBS PRACTICE
MN3K037MIOtherBCBS INDIVIDUAL
MN709825100Medicaid
MNT65868Medicare UPIN
MN359000219Medicare ID - Type UnspecifiedMEDICARE