Provider Demographics
NPI:1982881587
Name:MITCHELL, MELVA DENISE (DC)
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:DENISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7263 VANESSA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4335
Mailing Address - Country:US
Mailing Address - Phone:817-451-7853
Mailing Address - Fax:
Practice Address - Street 1:2521 OAKLAND BLVD
Practice Address - Street 2:106
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3292
Practice Address - Country:US
Practice Address - Phone:817-534-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10802111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation