Provider Demographics
NPI:1548380629
Name:MIKULA, PAUL ADAM (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ADAM
Last Name:MIKULA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22190 GARRISON
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2235
Mailing Address - Country:US
Mailing Address - Phone:313-274-3182
Mailing Address - Fax:313-359-1706
Practice Address - Street 1:22190 GARRISON
Practice Address - Street 2:SUITE 304
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2235
Practice Address - Country:US
Practice Address - Phone:313-274-3182
Practice Address - Fax:313-359-1706
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM79480Medicare ID - Type Unspecified