Provider Demographics
NPI:1427191345
Name:MITCHELL, MILES (DC)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:
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 1:7100 FUN CENTER WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5540
Mailing Address - Country:US
Mailing Address - Phone:206-932-1101
Mailing Address - Fax:
Practice Address - Street 1:7100 FUN CENTER WAY
Practice Address - Street 2:STE 120
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5540
Practice Address - Country:US
Practice Address - Phone:206-932-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor