Provider Demographics
NPI:1932105335
Name:MITZELFELD, CHARLES L (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:MITZELFELD
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 1:1395 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6016
Mailing Address - Country:US
Mailing Address - Phone:561-684-0333
Mailing Address - Fax:561-684-8587
Practice Address - Street 1:1395 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6016
Practice Address - Country:US
Practice Address - Phone:561-684-0333
Practice Address - Fax:561-684-8587
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381521800Medicaid
FL381521800Medicaid
FL70796ZMedicare PIN