Provider Demographics
NPI:1306873328
Name:MITCHELL, JEFFREY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 1:4205 GLASS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2514
Mailing Address - Country:US
Mailing Address - Phone:319-294-0094
Mailing Address - Fax:
Practice Address - Street 1:4205 GLASS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2514
Practice Address - Country:US
Practice Address - Phone:319-294-0094
Practice Address - Fax:319-294-0095
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00901771OtherRR MEDICARE
IA1386785293Medicaid
IA1386785293OtherWELLMARK BCBS
MNU97590Medicare UPIN
IA1386785293Medicaid