Provider Demographics
NPI:1538944723
Name:MITCHELL, GLENDA BONDAL (DC)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:BONDAL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 EXECUTIVE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2887
Mailing Address - Country:US
Mailing Address - Phone:757-949-6165
Mailing Address - Fax:
Practice Address - Street 1:1220 EXECUTIVE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2887
Practice Address - Country:US
Practice Address - Phone:757-949-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor