Provider Demographics
NPI:1699923946
Name:MICKO CHIROPRACTIC PC
Entity type:Organization
Organization Name:MICKO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-432-9561
Mailing Address - Street 1:1203 E 4TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1543
Mailing Address - Country:US
Mailing Address - Phone:605-432-9561
Mailing Address - Fax:605-432-9562
Practice Address - Street 1:1203 E 4TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1543
Practice Address - Country:US
Practice Address - Phone:605-432-9561
Practice Address - Fax:605-432-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1120261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1457530958OtherBCBS MN
SD1457530958Medicaid
SD1457530958OtherWELLMARK BCBS
1457530958OtherDAKOTACARE