Provider Demographics
NPI:1184814469
Name:JEFFREY R MITCHELL DC PC
Entity type:Organization
Organization Name:JEFFREY R MITCHELL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-652-1923
Mailing Address - Street 1:1918 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4867
Mailing Address - Country:US
Mailing Address - Phone:406-652-1923
Mailing Address - Fax:406-794-0742
Practice Address - Street 1:1918 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4867
Practice Address - Country:US
Practice Address - Phone:406-652-1923
Practice Address - Fax:406-794-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDE9031Medicare PIN
MT000082641Medicare PIN