Provider Demographics
NPI:1376595306
Name:TISHLER, MITCHELL SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:TISHLER
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 1:60 MUNSON MEETING WAY
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1992
Mailing Address - Country:US
Mailing Address - Phone:508-945-3131
Mailing Address - Fax:508-945-3132
Practice Address - Street 1:60 MUNSON MEETING WAY
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1992
Practice Address - Country:US
Practice Address - Phone:508-945-3131
Practice Address - Fax:508-945-3132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA797115OtherTUFTS HEALTH PLAN
MA35665OtherHARVARD PILGRIM
MAY35866OtherBLUE CROSS BLUE SHIELD
MAY35866Medicare ID - Type Unspecified
MA797115OtherTUFTS HEALTH PLAN