Provider Demographics
NPI:1205105541
Name:MILETELLO, MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MILETELLO
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 1:1002 GEMINI ST
Mailing Address - Street 2:SUITE 225W
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2746
Mailing Address - Country:US
Mailing Address - Phone:832-549-0838
Mailing Address - Fax:832-549-8719
Practice Address - Street 1:1002 GEMINI ST
Practice Address - Street 2:SUITE 225W
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2746
Practice Address - Country:US
Practice Address - Phone:832-549-0838
Practice Address - Fax:832-549-8719
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor