Provider Demographics
NPI:1467402966
Name:MITCHELL, VINCENT LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:LEE
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:PO BOX 4944
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4944
Mailing Address - Country:US
Mailing Address - Phone:228-385-0088
Mailing Address - Fax:228-385-0099
Practice Address - Street 1:2318 PASS RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4044
Practice Address - Country:US
Practice Address - Phone:228-385-0088
Practice Address - Fax:228-385-0099
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor