Provider Demographics
NPI:1275935991
Name:SHELLY MYCKA, DC, PC
Entity Type:Organization
Organization Name:SHELLY MYCKA, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYCKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-469-0700
Mailing Address - Street 1:2091 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8671
Mailing Address - Country:US
Mailing Address - Phone:610-469-0700
Mailing Address - Fax:
Practice Address - Street 1:2091 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-8671
Practice Address - Country:US
Practice Address - Phone:610-469-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006918R111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty