Provider Demographics
NPI:1427204700
Name:MICKEL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MICKEL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-576-1600
Mailing Address - Street 1:4421 NE ST JOHNS RD STE F
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2573
Mailing Address - Country:US
Mailing Address - Phone:360-576-1600
Mailing Address - Fax:360-693-0078
Practice Address - Street 1:6204 NE HIGHWAY 99
Practice Address - Street 2:SUITE C
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8746
Practice Address - Country:US
Practice Address - Phone:360-576-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty