Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5294 | MN |
N | 111NR0200X | Radiology | 5294 | MN |
N | 213ER0200X | Radiology | 5294 | MN |
NPI | 1184384760 |
---|---|
Provider Name | Michelle Mick |
First Address | Saint Paul, MN 55117-3504 |
Second Address | Saint Paul, MN 55117-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2021 |
Last Update Date | 23/12/2021 |