Provider Demographics
NPI:1902930266
Name:BARBARA GATES MITCHEM
Entity Type:Organization
Organization Name:BARBARA GATES MITCHEM
Other - Org Name:FAMILY CHIROPRACTIC & BRACING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:GATES
Authorized Official - Last Name:MITCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LO
Authorized Official - Phone:979-733-9500
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-0627
Mailing Address - Country:US
Mailing Address - Phone:979-733-9500
Mailing Address - Fax:979-733-9501
Practice Address - Street 1:109 SHULT DR
Practice Address - Street 2:SUITE 208
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3009
Practice Address - Country:US
Practice Address - Phone:979-733-9500
Practice Address - Fax:979-733-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1197332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5871620001Medicare NSC
TX00X575Medicare PIN