Provider Demographics
NPI:1770729097
Name:MIKULA CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MIKULA CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-365-0255
Mailing Address - Street 1:4056 PLAINFIELD AVE NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1630
Mailing Address - Country:US
Mailing Address - Phone:616-365-0255
Mailing Address - Fax:616-365-0975
Practice Address - Street 1:4056 PLAINFIELD AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1630
Practice Address - Country:US
Practice Address - Phone:616-365-0255
Practice Address - Fax:616-365-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007184111N00000X
MI2301007183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP61830001OtherMEDICARE PROVIDER ENROLLMENT PTAN
MI14443376Medicaid
MI950D120100OtherBLUE CROSS/BLUE SHIELD
MIOD15062753OtherBLUE CARE NETWORK
MI13269896Medicaid
MI950D120110OtherBLUE CROSS/BLUE SHIELD
MI0D15065OtherBLUE CARE NETWORK
MI0D115053OtherBLUE CARE NETWORK
MIP61830002OtherMEDICARE PROVIDER ENROLLMENT PTAN
MI0P61830OtherMEDICARE PROVIDER ENROLLMENT PTAN
MI950D120100OtherBLUE CROSS/BLUE SHIELD
MI0D15065OtherBLUE CARE NETWORK
MIOD15062753OtherBLUE CARE NETWORK
MIU59286Medicare UPIN