Provider Demographics
NPI:1427471606
Name:GREXA, MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:GREXA
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 1:1750 MARIETTA HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8387
Mailing Address - Country:US
Mailing Address - Phone:770-213-7602
Mailing Address - Fax:770-213-7604
Practice Address - Street 1:1750 MARIETTA HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8387
Practice Address - Country:US
Practice Address - Phone:770-213-7602
Practice Address - Fax:770-213-7604
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor