Healthcare Provider Details

I. General information

NPI: 1417175381
Provider Name (Legal Business Name): OLIVER HERBERT MITCHELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PARK AVE
LOVELL WY
82431-1622
US

IV. Provider business mailing address

203 PARK AVE
LOVELL WY
82431-1622
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7020
  • Fax: 307-548-7020
Mailing address:
  • Phone: 307-548-7020
  • Fax: 307-548-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number624
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: