Provider Demographics
NPI:1396858379
Name:CROSS, MITCHELL T (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:T
Last Name:CROSS
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 1:3324 N LEAVITT ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6224
Mailing Address - Country:US
Mailing Address - Phone:773-404-7739
Mailing Address - Fax:773-868-0645
Practice Address - Street 1:905 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2923
Practice Address - Country:US
Practice Address - Phone:773-868-0644
Practice Address - Fax:773-868-0645
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor