Provider Demographics
NPI:1386245785
Name:WADE, MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:WADE
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 1:6790 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8385
Mailing Address - Country:US
Mailing Address - Phone:614-833-0563
Mailing Address - Fax:614-833-0916
Practice Address - Street 1:6790 THRUSH DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8385
Practice Address - Country:US
Practice Address - Phone:614-833-0563
Practice Address - Fax:614-833-0916
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor