Provider Demographics
NPI:1619116944
Name:MITCHELL, STEVEN GLENN (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GLENN
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 HAYVENHURST AVE
Mailing Address - Street 2:SUITE #109
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3874
Mailing Address - Country:US
Mailing Address - Phone:818-786-8448
Mailing Address - Fax:
Practice Address - Street 1:7100 HAYVENHURST AVE.
Practice Address - Street 2:SUITE #109
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2533
Practice Address - Country:US
Practice Address - Phone:818-786-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor