Individual
DR. BRUCE DOUGLAS MIKOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC CCSP
Contact information
Practice address
111 WEST RUTLEDGE AVENUE, GAFFNEY, SC 29340
(864) 489-2444
(864) 489-6948
Mailing address
PO BOX 1825, GAFFNEY, SC 29342
(854) 489-2444
(864) 489-6948
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
697
SC
111N00000X
Chiropractor
799
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CHO697
—
SC
Enumeration date
06/27/2006
Last updated
07/08/2007
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