Provider Demographics
NPI:1073801064
Name:MITCHELL, AMANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8792 STATE ROAD 70 E STE 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3706
Mailing Address - Country:US
Mailing Address - Phone:941-756-4362
Mailing Address - Fax:
Practice Address - Street 1:8792 STATE ROAD 70 E STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3706
Practice Address - Country:US
Practice Address - Phone:941-756-4362
Practice Address - Fax:941-755-4652
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor