Provider Demographics
NPI:1619169786
Name:DR JACK P MITCHELL P C
Entity Type:Organization
Organization Name:DR JACK P MITCHELL P C
Other - Org Name:MITCHELL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-759-2533
Mailing Address - Street 1:PO BOX 9159
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9159
Mailing Address - Country:US
Mailing Address - Phone:903-759-2533
Mailing Address - Fax:
Practice Address - Street 1:1011 W LOOP 281
Practice Address - Street 2:STE.9
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2970
Practice Address - Country:US
Practice Address - Phone:903-759-2533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00122YMedicare PIN
TXU67634Medicare UPIN