Provider Demographics
NPI:1225038292
Name:MITCHELL, BONNIE H (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:H
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 1:8103 BROADWAY ST
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1917
Mailing Address - Country:US
Mailing Address - Phone:210-804-1215
Mailing Address - Fax:210-804-1280
Practice Address - Street 1:8103 BROADWAY ST
Practice Address - Street 2:STE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1917
Practice Address - Country:US
Practice Address - Phone:210-804-1215
Practice Address - Fax:210-804-1280
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO6091437Medicaid
TXCO6091437Medicaid