Provider Demographics
NPI:1972584555
Name:STICK-MUELLER, MISTY D (DC)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:D
Last Name:STICK-MUELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:D
Other - Last Name:STICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1000 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5214
Mailing Address - Country:US
Mailing Address - Phone:563-884-5810
Mailing Address - Fax:
Practice Address - Street 1:1000 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5214
Practice Address - Country:US
Practice Address - Phone:563-884-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35961OtherBLUE CROSS BLUE SHIELD
IAU92097Medicare UPIN
IAI11005Medicare ID - Type Unspecified