Provider Demographics
NPI:1427149277
Name:MITCHELL, JEFFREY RUSSELL (DC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RUSSELL
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 1:1918 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4867
Mailing Address - Country:US
Mailing Address - Phone:406-969-3805
Mailing Address - Fax:406-969-3806
Practice Address - Street 1:1918 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4867
Practice Address - Country:US
Practice Address - Phone:406-969-3805
Practice Address - Fax:406-969-3806
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1017CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP01046796OtherRAILROAD MEDICARE PTAN
MTM011001947OtherMEDICARE PTAN
MTU90403Medicare UPIN
MT350054921Medicare PIN