Provider Demographics
NPI:1922270131
Name:MITCHELL, KEVIN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:JAY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2012 PROVIDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6384
Mailing Address - Country:US
Mailing Address - Phone:615-883-4244
Mailing Address - Fax:615-490-6630
Practice Address - Street 1:2012 PROVIDENCE PKWY
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6384
Practice Address - Country:US
Practice Address - Phone:615-883-4244
Practice Address - Fax:615-490-6630
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2261OtherTEMP. LICENSE