Provider Demographics
NPI:1679542260
Name:MISKELLY, WILLIAM J (D C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MISKELLY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LOWER HUNTINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2616
Mailing Address - Country:US
Mailing Address - Phone:260-747-1596
Mailing Address - Fax:260-747-1597
Practice Address - Street 1:2811 LOWER HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-2616
Practice Address - Country:US
Practice Address - Phone:260-747-1596
Practice Address - Fax:260-747-1597
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000497A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175462OtherBLUE CROSS BLUE SHIELD
IN000000175462OtherBLUE CROSS BLUE SHIELD