Provider Demographics
NPI:1417175381
Name:MITCHELL, OLIVER HERBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:HERBERT
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 1:203 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1622
Mailing Address - Country:US
Mailing Address - Phone:307-548-7020
Mailing Address - Fax:307-548-7020
Practice Address - Street 1:203 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-1622
Practice Address - Country:US
Practice Address - Phone:307-548-7020
Practice Address - Fax:307-548-7020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9846Medicare ID - Type Unspecified