Healthcare Provider Details

I. General information

NPI: 1932116399
Provider Name (Legal Business Name): TOBY ANDREW MITCHELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E MAIN ST
NILES MI
49120-3650
US

IV. Provider business mailing address

PO BOX 725
NILES MI
49120-0725
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-6000
  • Fax: 269-683-6350
Mailing address:
  • Phone: 269-683-6000
  • Fax: 269-683-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007476
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501001411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: