Provider Demographics
NPI:1902951767
Name:MITCHELL, JOHN B (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2612
Mailing Address - Country:US
Mailing Address - Phone:978-365-6044
Mailing Address - Fax:978-365-2533
Practice Address - Street 1:106 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2612
Practice Address - Country:US
Practice Address - Phone:978-365-6044
Practice Address - Fax:978-365-2533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1379111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT90163Medicare UPIN
MAY35928Medicare ID - Type Unspecified