Provider Demographics
NPI:1215959374
Name:MIKULA, DAVID JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:MIKULA
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 1:1343 N ATHERTON ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2932
Mailing Address - Country:US
Mailing Address - Phone:814-234-6699
Mailing Address - Fax:814-234-6899
Practice Address - Street 1:1343 N ATHERTON ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2932
Practice Address - Country:US
Practice Address - Phone:814-234-6699
Practice Address - Fax:814-234-6899
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005374L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03087900OtherCAPITAL BLUE CROSS
PRMI1346487OtherPA BLUE SHIELD
PA355775OtherKEYSTONE
PAMI20627OtherHIGHMARK
PAMI020627Medicare ID - Type Unspecified
PA03087900OtherCAPITAL BLUE CROSS