Provider Demographics
NPI:1932500212
Name:PERNAL, MITCHELL ANDREW II (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ANDREW
Last Name:PERNAL
Suffix:II
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 1:728 BENNETTS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3850
Mailing Address - Country:US
Mailing Address - Phone:732-415-1401
Mailing Address - Fax:
Practice Address - Street 1:728 BENNETTS MILLS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3850
Practice Address - Country:US
Practice Address - Phone:732-415-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00689100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor