Provider Demographics
NPI:1073703450
Name:MAHLE, MITCHELL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JOHN
Last Name:MAHLE
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 1:101 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1501
Mailing Address - Country:US
Mailing Address - Phone:724-656-9050
Mailing Address - Fax:724-656-5899
Practice Address - Street 1:101 DECKER DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1501
Practice Address - Country:US
Practice Address - Phone:724-656-9050
Practice Address - Fax:724-656-5899
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007953L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA9159OtherPALMETTO GBA
PAMA001685728OtherHIGHMARK BLUE SHIELD
PA051392SNRMedicare PIN