Provider Demographics
NPI:1528156478
Name:MICKELSON, STEVEN ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:MICKELSON
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54742-0338
Mailing Address - Country:US
Mailing Address - Phone:715-877-2880
Mailing Address - Fax:715-877-3451
Practice Address - Street 1:237 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FALL CREEK
Practice Address - State:WI
Practice Address - Zip Code:54742-9362
Practice Address - Country:US
Practice Address - Phone:715-877-2880
Practice Address - Fax:715-877-3451
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1316-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38827700Medicaid