Provider Demographics
NPI:1225058704
Name:DOLEZAL, MICAELA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:SUE
Last Name:DOLEZAL
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 1:3100 CEDAR CREST RDG
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-6700
Mailing Address - Country:US
Mailing Address - Phone:563-557-3040
Mailing Address - Fax:563-557-3048
Practice Address - Street 1:3100 CEDAR CREST RDG
Practice Address - Street 2:SUITE 4
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-6700
Practice Address - Country:US
Practice Address - Phone:563-557-3040
Practice Address - Fax:563-557-3048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06658111N00000X
IL038-010052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1468967Medicaid
IA1468967Medicaid
U98936Medicare UPIN