Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC32935 | CA |
N | 111NN1001X | Nutrition | DC32935 | CA |
N | 111NP0017X | Pediatric Chiropractor | DC32935 | CA |
NPI | 1477921054 |
---|---|
Provider Name | Melissa Evangeline Mitchell |
First Address | Costa Mesa, CA 92626-5981 |
Second Address | Costa Mesa, CA 92626-5981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2015 |
Last Update Date | 12/09/2015 |