Provider Demographics
NPI:1700093242
Name:MITTET, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MITTET
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 1:120 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557-0121
Mailing Address - Country:US
Mailing Address - Phone:218-935-5590
Mailing Address - Fax:218-935-5590
Practice Address - Street 1:120 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-0121
Practice Address - Country:US
Practice Address - Phone:218-935-5590
Practice Address - Fax:218-935-5590
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1B60972MIOtherBLUECROSS&BLUESHIELDMN
ND4904OtherBLUECROSS&BLUESHIELDND