Provider Demographics
NPI:1932116399
Name:MITCHELL, TOBY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:ANDREW
Last Name:MITCHELL
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:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0725
Mailing Address - Country:US
Mailing Address - Phone:269-683-6000
Mailing Address - Fax:269-683-6350
Practice Address - Street 1:1340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3650
Practice Address - Country:US
Practice Address - Phone:269-683-6000
Practice Address - Fax:269-683-6350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007476111N00000X
MI7501001411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A150310OtherBLUECROSS/BLUESHIELD
MI3371503Medicaid
MIU67817Medicare UPIN
MIU67817Medicare UPIN