Provider Demographics
NPI:1235168873
Name:MITCHELL, THOMAS KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENT
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 1:2500 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6469
Mailing Address - Country:US
Mailing Address - Phone:919-785-2200
Mailing Address - Fax:919-785-2211
Practice Address - Street 1:2500 BLUE RIDGE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6469
Practice Address - Country:US
Practice Address - Phone:919-785-2200
Practice Address - Fax:919-785-2211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890828UMedicaid
NC2451781Medicare ID - Type Unspecified
NC890828UMedicaid