Provider Demographics
NPI:1134281322
Name:MIKLOS CENTER FOR HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:MIKLOS CENTER FOR HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MIKLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-967-5545
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-0413
Mailing Address - Country:US
Mailing Address - Phone:440-967-5545
Mailing Address - Fax:440-967-5546
Practice Address - Street 1:4550 LIBERTY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1910
Practice Address - Country:US
Practice Address - Phone:440-967-5545
Practice Address - Fax:440-967-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9342891Medicare PIN