Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2731 | OH |
NPI | 1538199351 |
---|---|
Provider Name | Dr. Michael Paul Kieklak |
First Address | Parma, OH 44134-3167 |
Second Address | Parma, OH 44134-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 13/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1281458 | BWC PROVIDER NO. (01) | OH |
2106705 | (05) | OH |