Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | CH7489 | FL |
N | 111NX0100X | Occupational Health | CH7489 | FL |
NPI | 1538217385 |
---|---|
Provider Name | Dr. Ted David Mitchell SR. |
First Address | Jacksonville, FL 32241-6113 |
Second Address | Jacksonville, FL 32204-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |