Provider Demographics
NPI:1871815134
Name:MITCHELL, SAMUEL JUSTIN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JUSTIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 9TH AVENUE CIR NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9559
Mailing Address - Country:US
Mailing Address - Phone:727-560-5559
Mailing Address - Fax:
Practice Address - Street 1:8792 STATE ROAD 70 E STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3706
Practice Address - Country:US
Practice Address - Phone:941-756-4362
Practice Address - Fax:941-755-4652
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor