Provider Demographics
NPI:1467454587
Name:MICETICH, JULI WEBER (DC)
Entity Type:Individual
Prefix:DR
First Name:JULI
Middle Name:WEBER
Last Name:MICETICH
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 1:24 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1087
Mailing Address - Country:US
Mailing Address - Phone:815-634-0445
Mailing Address - Fax:
Practice Address - Street 1:24 E NORTH ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1087
Practice Address - Country:US
Practice Address - Phone:815-634-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350054286OtherRAILROAD MEDICARE
IL350054286OtherRAILROAD MEDICARE
ILU61091Medicare UPIN