Healthcare Provider Details

I. General information

NPI: 1982968012
Provider Name (Legal Business Name): LIONEL GRANT MITCHELL D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

14277 E FRIDEGER RD
ELK WA
99009-9708
US

V. Phone/Fax

Practice location:
  • Phone: 404-309-5557
  • Fax:
Mailing address:
  • Phone: 509-292-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60286319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: