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General NPI Number Information
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NPI Number | 1316594906
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Entity Type | Individual
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Provider Name | SYDNEY LEIGH MITTON DC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 37283 SWAMP RD STE 1001
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3298
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Country | US
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Telephone | 225-744-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 812 MCCULLA ST
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City | THIBODAUX
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State | LA
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Zip | 70301-4729
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Country | US
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Telephone | 484-941-3733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1874
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License Number State | LA
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