NPIMap

Organization Active NPI

Dr Thomas J Mickelsen, P.C.

  • Chiropractor
  • Livonia, MI
National Provider Identifier
1083782858
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301007193 Issued in MI
Legal business name
DR THOMAS J MICKELSEN, P.C.
Practice address
37625 Ann Arbor Rd
Suite 111
Livonia, MI 48150-2400
Phone
(734) 462-2262
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas James Mickelsen, D.C.
Title
Chiropractor
Phone
(734) 462-2262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301007193 MI Primary

Addresses

Primary practice location

37625 Ann Arbor Rd
Suite 111
Livonia, MI 48150-2400

Mailing address

6635 Wing Lake Rd
Bloomfield Hills, MI 48301-2955
Phone (248) 626-1116

Other identifiers 4

IdentifierTypeStateIssuer
3231745MedicaidMI
U60541OtherMIHAP PROVIDER NUMBER
CH820105OtherMIMCARE PROVIDER NUMBER
5599151OtherMIAETNA PROVIDER NUMBER

Other names 1

  • MICKELSEN CHIROPRACTIC CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

37625 Ann Arbor Rd
Ste 111
Livonia, MI 48150
Phone (734) 462-2262

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083782858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 WING LAKE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483012955",
            "telephone_number": "248-626-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37625 ANN ARBOR RD",
            "address_2": "SUITE 111",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481502400",
            "telephone_number": "734-462-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR THOMAS J MICKELSEN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICKELSEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "734-462-2262",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301007193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3231745",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP PROVIDER NUMBER",
            "identifier": "U60541",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE PROVIDER NUMBER",
            "identifier": "CH820105",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "5599151",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MICKELSEN CHIROPRACTIC CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.