Provider Demographics
NPI:1295978120
Name:MITCHELL, JASON (MS LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2215
Mailing Address - Country:US
Mailing Address - Phone:510-292-8447
Mailing Address - Fax:510-558-8808
Practice Address - Street 1:1738 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2215
Practice Address - Country:US
Practice Address - Phone:510-292-8447
Practice Address - Fax:510-558-8808
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist