Organization
DR THOMAS J MICKELSEN, P.C.
Active
Other names
MICKELSEN CHIROPRACTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JAMES MICKELSEN D.C. (CHIROPRACTOR)
(734) 462-2262
Entity
Organization
Contact information
Practice address
37625 ANN ARBOR RD, SUITE 111, LIVONIA, MI 48150-2400
(734) 462-2262
Mailing address
6635 WING LAKE RD, BLOOMFIELD HILLS, MI 48301-2955
(248) 626-1116
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301007193
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3231745
—
MI
01
—
5599151
AETNA PROVIDER NUMBER
MI
01
—
CH820105
MCARE PROVIDER NUMBER
MI
01
—
U60541
HAP PROVIDER NUMBER
MI
Enumeration date
12/01/2006
Last updated
08/22/2020
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