Provider Demographics
NPI:1134231434
Name:HARVILLE, MITCHELL BLAKE (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:BLAKE
Last Name:HARVILLE
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 1:3967 PRESIDENTIAL PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7270
Mailing Address - Country:US
Mailing Address - Phone:614-791-0663
Mailing Address - Fax:614-791-8199
Practice Address - Street 1:3967 PRESIDENTIAL PKWY STE B
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7270
Practice Address - Country:US
Practice Address - Phone:614-791-0663
Practice Address - Fax:614-791-8199
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU60070Medicare UPIN