Provider Demographics
NPI:1437286739
Name:MITNOWSKY, ELLEN J (DC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:J
Last Name:MITNOWSKY
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 1:432 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MA
Mailing Address - Zip Code:01351-8925
Mailing Address - Country:US
Mailing Address - Phone:413-772-0612
Mailing Address - Fax:413-772-1029
Practice Address - Street 1:432 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MA
Practice Address - Zip Code:01351-8925
Practice Address - Country:US
Practice Address - Phone:413-772-0612
Practice Address - Fax:413-772-1029
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36495OtherBLUE CROSS BLUE SHIELD
MAY36495OtherBLUE CROSS BLUE SHIELD