Provider Demographics
NPI:1902105315
Name:MICKA, NICHOLAS ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:MICKA
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 1:4921 E STATE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2275
Mailing Address - Country:US
Mailing Address - Phone:217-253-2370
Mailing Address - Fax:217-253-6545
Practice Address - Street 1:902 S COURT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-2000
Practice Address - Country:US
Practice Address - Phone:217-253-2370
Practice Address - Fax:217-253-6545
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor