Provider Demographics
NPI:1992902779
Name:MITCHELL, GERALD M (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
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 1:243 STURGES HWY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1721
Mailing Address - Country:US
Mailing Address - Phone:203-557-3414
Mailing Address - Fax:212-792-6020
Practice Address - Street 1:145 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3763
Practice Address - Country:US
Practice Address - Phone:212-260-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234510Medicare ID - Type UnspecifiedCHIROPRACTOR