Physician Compare National (NPI:1760910343)

HEALTHCARE PROVIDER: MITCHELL DALE SUTTON DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1760910343
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082982590
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170623001475
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SUTTON
	Individual professional last name
Provider First Name	MITCHELL
	Individual professional first name
Provider Middle Name	DALE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHWESTERN COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	THE WELLNESS WAY GREEN BAY LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4284680463
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2638 TULIP LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	GREEN BAY
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	543132801
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9204292844
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y