Healthcare Provider Details

I. General information

NPI: 1700093242
Provider Name (Legal Business Name): DAVID JOHN MITTET D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SOUTH MAIN STREET
MAHNOMEN MN
56557-0121
US

IV. Provider business mailing address

120 MAIN ST
MAHNOMEN MN
56557-0121
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-5590
  • Fax: 218-935-5590
Mailing address:
  • Phone: 218-935-5590
  • Fax: 218-935-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMN2622
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: