Provider Demographics
NPI:1225295025
Name:MITCHNICK, TANYA (DC)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:MITCHNICK
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 1:50 VASHELL WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563
Mailing Address - Country:US
Mailing Address - Phone:510-853-4694
Mailing Address - Fax:925-253-9505
Practice Address - Street 1:50 VASHELL WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:510-853-4694
Practice Address - Fax:925-253-9505
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor