Provider Demographics
NPI:1346314242
Name:MIHALKO CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MIHALKO CHIROPRACTIC PC
Other - Org Name:STACEY MIHALKO DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MIHALKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-826-4136
Mailing Address - Street 1:217 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071
Mailing Address - Country:US
Mailing Address - Phone:610-826-4136
Mailing Address - Fax:610-824-6515
Practice Address - Street 1:217 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071
Practice Address - Country:US
Practice Address - Phone:610-826-4136
Practice Address - Fax:610-824-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007606L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1786509Medicaid
PA753161OtherCAP BC
PA753161OtherBS
PA753161OtherCAP BC
U77710Medicare UPIN