Provider Demographics
NPI:1407177405
Name:STEVEN MIKULAK DC PLC
Entity Type:Organization
Organization Name:STEVEN MIKULAK DC PLC
Other - Org Name:HEALTHY LIFE PAIN & PERFORMANCE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKULAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-866-0150
Mailing Address - Street 1:120 MARCELL DR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1362
Mailing Address - Country:US
Mailing Address - Phone:616-866-0150
Mailing Address - Fax:616-866-7771
Practice Address - Street 1:120 MARCELL DR NE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1362
Practice Address - Country:US
Practice Address - Phone:616-866-0150
Practice Address - Fax:616-866-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty