Provider Demographics
NPI:1124057401
Name:MIKLO, MONICA M (DC)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:MIKLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2817
Mailing Address - Country:US
Mailing Address - Phone:330-493-9340
Mailing Address - Fax:330-493-9681
Practice Address - Street 1:4065 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2817
Practice Address - Country:US
Practice Address - Phone:330-493-9340
Practice Address - Fax:330-493-9681
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor