Provider Demographics
NPI:1104122522
Name:MITCHELL, NOLAN EC (DC)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:EC
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 1:2000 13TH AVE W
Mailing Address - Street 2:APT. 2
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1960
Mailing Address - Country:US
Mailing Address - Phone:701-269-2342
Mailing Address - Fax:952-944-1673
Practice Address - Street 1:8577 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-9001
Practice Address - Country:US
Practice Address - Phone:952-479-0043
Practice Address - Fax:952-944-1673
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor