Provider Demographics
NPI:1164815577
Name:MITCHELL, NICHOLAS MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
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 1:101 CONEY ST W
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-2117
Mailing Address - Country:US
Mailing Address - Phone:218-346-2225
Mailing Address - Fax:218-346-5128
Practice Address - Street 1:101 CONEY ST W
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-2117
Practice Address - Country:US
Practice Address - Phone:218-346-2225
Practice Address - Fax:218-346-5128
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor