Provider Demographics
NPI:1790907434
Name:MICKLE, BILL EVERETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:EVERETT
Last Name:MICKLE
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 1:1260 STATE HWY 25 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8447
Mailing Address - Country:US
Mailing Address - Phone:651-238-2006
Mailing Address - Fax:
Practice Address - Street 1:1260 STATE HWY 25 SOUTH
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8447
Practice Address - Country:US
Practice Address - Phone:651-238-2006
Practice Address - Fax:763-295-2208
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor