Provider Demographics
NPI:1528169224
Name:MITCHELL, DAVID THOMAS (DC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
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 1:6929 HIGHLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1679
Mailing Address - Country:US
Mailing Address - Phone:248-698-6920
Mailing Address - Fax:248-698-6923
Practice Address - Street 1:6929 HIGHLAND ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1679
Practice Address - Country:US
Practice Address - Phone:248-698-6920
Practice Address - Fax:248-698-6923
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM006064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103833049Medicaid
MI090F35490OtherBLUE CROSS BLUE SHIELD OF
MI090F35490OtherBLUE CROSS BLUE SHIELD OF
U55724Medicare UPIN