Provider Demographics
NPI:1881725372
Name:PFEIFFER, MITCHELL DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:DEAN
Last Name:PFEIFFER
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 1:123 W HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-1239
Mailing Address - Country:US
Mailing Address - Phone:440-647-5200
Mailing Address - Fax:440-647-5301
Practice Address - Street 1:123 W HERRICK AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-1239
Practice Address - Country:US
Practice Address - Phone:440-647-5200
Practice Address - Fax:440-647-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0784012Medicaid
OH000000140250OtherANTHEM INS ID
OHU20575Medicare UPIN