Provider Demographics
NPI:1124397161
Name:MITCHELL, NICHOLAS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WAYNE
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 1:1970 N CENTRAL EXPY STE 170
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2907
Mailing Address - Country:US
Mailing Address - Phone:214-544-2886
Mailing Address - Fax:469-742-0566
Practice Address - Street 1:1970 N CENTRAL EXPY STE 170
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2907
Practice Address - Country:US
Practice Address - Phone:214-544-2886
Practice Address - Fax:469-742-0566
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor