Provider Demographics
NPI:1801915103
Name:LEVY, MITCHELL BRUCE (DC)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:BRUCE
Last Name:LEVY
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 1:466 HOLLYWOOD MALL
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6932
Mailing Address - Country:US
Mailing Address - Phone:954-981-4355
Mailing Address - Fax:954-981-8311
Practice Address - Street 1:466 HOLLYWOOD MALL
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6932
Practice Address - Country:US
Practice Address - Phone:954-981-4355
Practice Address - Fax:954-981-8311
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU77267Medicare UPIN