Provider Demographics
NPI:1265839385
Name:MITTS, DAVID (LICAC)
Entity Type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:
Last Name:MITTS
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 E BELLA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-0082
Mailing Address - Country:US
Mailing Address - Phone:425-306-2926
Mailing Address - Fax:
Practice Address - Street 1:3681 N ROBERT RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8568
Practice Address - Country:US
Practice Address - Phone:928-514-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist