Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13357 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 13357 | CA |
NPI | 1326207804 |
---|---|
Provider Name | Dr. Gary A Mitchell |
First Address | Santa Monica, CA 90405-4950 |
Second Address | Santa Monica, CA 90405-4950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |