Provider Demographics
NPI:1609769256
Name:MCMICKING, JOHN (CPO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCMICKING
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 SAINT MATTHEWS RD # B
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1344
Mailing Address - Country:US
Mailing Address - Phone:803-534-6567
Mailing Address - Fax:
Practice Address - Street 1:2664 SAINT MATTHEWS RD # B
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1344
Practice Address - Country:US
Practice Address - Phone:803-534-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist