Provider Demographics
NPI:1508952854
Name:MYKAL AND ASSOCIATES INC
Entity Type:Organization
Organization Name:MYKAL AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MISHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-876-6096
Mailing Address - Street 1:1950 POTTERY AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2592
Mailing Address - Country:US
Mailing Address - Phone:360-876-6096
Mailing Address - Fax:
Practice Address - Street 1:1950 POTTERY AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2592
Practice Address - Country:US
Practice Address - Phone:360-876-6096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862582Medicare PIN