Provider Demographics
NPI:1275826992
Name:MITCHELL, MELODIE JEANINE (DC)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:JEANINE
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 1:1000 EXECUTIVE LN NW APT C
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7592
Mailing Address - Country:US
Mailing Address - Phone:404-915-8623
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:SUITE 510
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:404-915-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor