Provider Demographics
NPI:1649742610
Name:JENNIFER L MITCHEL, DC, PC
Entity Type:Organization
Organization Name:JENNIFER L MITCHEL, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MCCLURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-251-5590
Mailing Address - Street 1:6681A WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-2053
Mailing Address - Country:US
Mailing Address - Phone:720-251-5590
Mailing Address - Fax:315-748-5319
Practice Address - Street 1:26121 US ROUTE 11 UNIT 1B
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3318
Practice Address - Country:US
Practice Address - Phone:720-251-5590
Practice Address - Fax:315-748-5319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center