MEDICARE: SCOTT A MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14196	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811548415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT A MITCHELL

Provider Business Mailing Address
First Line	:	2612 S LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4733
Country	:	US
Telephone Number	:	512-400-1241
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 S LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4733
Country	:	US
Telephone Number	:	512-400-1241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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Directions to “ SCOTT A MITCHELL ” Practice Location

Language	Start Address	Practice Location

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