Provider Demographics
NPI:1710004932
Name:MITCHELL, BETSY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:J
Last Name:MITCHELL
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 1:3701 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3835
Mailing Address - Country:US
Mailing Address - Phone:503-234-2080
Mailing Address - Fax:503-234-2090
Practice Address - Street 1:3701 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3835
Practice Address - Country:US
Practice Address - Phone:503-234-2080
Practice Address - Fax:503-234-2090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273184111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR116454Medicare ID - Type Unspecified