Organization
BIG LAKE SPINE & SPORT, PA
Active
Other names
Great River Spine & Sport
Organization subpart
No
Provider details
NPI number
Authorized official
BILL E MICKLE DC (OWNER)
(763) 260-8401
Entity
Organization
Contact information
Practice address
1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
(763) 260-8401
(763) 295-2208
Mailing address
1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
(763) 260-8401
(763) 263-5900
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3548
MN
Other
Enumeration date
08/12/2006
Last updated
10/18/2019
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