Provider Demographics
NPI:1750034179
Name:FLACK, MITCHELL PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:PAUL
Last Name:FLACK
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 1:17940 WELCH PLAZA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4964
Mailing Address - Country:US
Mailing Address - Phone:531-999-2080
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-4964
Practice Address - Country:US
Practice Address - Phone:531-999-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112604111N00000X
NE2111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor