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General NPI Number Information
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NPI Number | 1376959130
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Entity Type | Individual
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Provider Name | MITCHELL DRAKE CRISWELL D.T.C.M., LIC. AC.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 1150 OLD US HIGHWAY 1 S SUITE 3
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-6341
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Country | US
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Telephone | 910-693-7905
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 OLD US HIGHWAY 1 S SUITE 3
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-6341
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Country | US
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Telephone | 910-693-7905
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 00043
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License Number State | NC
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