Provider Demographics
NPI:1043475841
Name:MIKULAK, STEVEN ANDREW (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
Last Name:MIKULAK
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 1:65 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1286
Mailing Address - Country:US
Mailing Address - Phone:616-866-0150
Mailing Address - Fax:616-866-7771
Practice Address - Street 1:65 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1286
Practice Address - Country:US
Practice Address - Phone:616-866-0150
Practice Address - Fax:616-866-7771
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor