Provider Demographics
NPI:1902256506
Name:MICKELSON, HEATHER LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEIGH
Last Name:MICKELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17191 COUNTY HIGHWAY X
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-8057
Mailing Address - Country:US
Mailing Address - Phone:715-723-3333
Mailing Address - Fax:175-723-3309
Practice Address - Street 1:17191 COUNTY HIGHWAY X
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-8057
Practice Address - Country:US
Practice Address - Phone:715-723-3333
Practice Address - Fax:175-723-3309
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor