Provider Demographics
NPI:1851562524
Name:JOMSKY, MITCHELL G (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:G
Last Name:JOMSKY
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 1:6823 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5601
Mailing Address - Country:US
Mailing Address - Phone:954-981-8808
Mailing Address - Fax:
Practice Address - Street 1:6823 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5601
Practice Address - Country:US
Practice Address - Phone:954-981-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU29886Medicare UPIN
FL22736Medicare PIN