Provider Demographics
NPI:1124413687
Name:MITCHELL, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
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 1:6002 WESTGATE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2580
Mailing Address - Country:US
Mailing Address - Phone:253-722-6150
Mailing Address - Fax:
Practice Address - Street 1:6002 WESTGATE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2580
Practice Address - Country:US
Practice Address - Phone:253-722-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60447293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8940952Medicare PIN