Healthcare Provider Details

I. General information

NPI: 1598828741
Provider Name (Legal Business Name): MATTHEW BOOTH MITCHELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 WELSH RD SUITE A120
NORTH WALES PA
19454-1913
US

IV. Provider business mailing address

5045 YUKON DR
EAST STROUDSBURG PA
18302-6634
US

V. Phone/Fax

Practice location:
  • Phone: 215-628-2529
  • Fax:
Mailing address:
  • Phone: 724-255-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 008845
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: