Healthcare Provider Details

I. General information

NPI: 1710004932
Provider Name (Legal Business Name): BETSY J MITCHELL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SE MILWAUKIE AVE
PORTLAND OR
97202-3835
US

IV. Provider business mailing address

3701 SE MILWAUKIE AVE
PORTLAND OR
97202-3835
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-2080
  • Fax: 503-234-2090
Mailing address:
  • Phone: 503-234-2080
  • Fax: 503-234-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number273184
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: