Healthcare Provider Details

I. General information

NPI: 1396749719
Provider Name (Legal Business Name): MITCHELL HARRY MARR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 S ORTONVILLE RD
ORTONVILLE MI
48462-8819
US

IV. Provider business mailing address

1770 S ORTONVILLE RD
ORTONVILLE MI
48462-8819
US

V. Phone/Fax

Practice location:
  • Phone: 248-627-8264
  • Fax: 248-627-7370
Mailing address:
  • Phone: 248-627-8264
  • Fax: 248-627-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMM 005040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: