Provider Demographics
NPI:1790812709
Name:MICKEL, REUBEN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:JAMES
Last Name:MICKEL
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 1:4421 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 1:4421 NE ST JOHNS RD STE F
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2573
Practice Address - Country:US
Practice Address - Phone:360-576-1600
Practice Address - Fax:360-693-0078
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB20332Medicare ID - Type Unspecified
WAU84760Medicare UPIN