Provider Demographics
NPI:1396745295
Name:LEVINE, MITCHELL B (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:B
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4309
Mailing Address - Country:US
Mailing Address - Phone:516-482-3156
Mailing Address - Fax:516-482-3157
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-3156
Practice Address - Fax:516-482-3157
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX003485111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX19581Medicare ID - Type UnspecifiedCHIROPRACTOR