Provider Demographics
NPI:1538217385
Name:MITCHELL, TED DAVID SR
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:DAVID
Last Name:MITCHELL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-6113
Mailing Address - Country:US
Mailing Address - Phone:904-636-0282
Mailing Address - Fax:904-285-3857
Practice Address - Street 1:1820 BARRS ST
Practice Address - Street 2:SUITE 601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4742
Practice Address - Country:US
Practice Address - Phone:904-636-0282
Practice Address - Fax:904-285-3857
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7489111NR0400X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health