1184876187 NPI number — MITCHELL CHIROPRACTIC CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184876187 NPI number — MITCHELL CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL CHIROPRACTIC CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184876187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 DAVID ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SINTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78387-2913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-241-7451
Provider Business Mailing Address Fax Number:
361-241-7452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 US HIGHWAY 77
Provider Second Line Business Practice Location Address:
M-5
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78410-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-241-7451
Provider Business Practice Location Address Fax Number:
361-241-7452
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-241-7451

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  10888 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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