Physician Compare National (NPI:1992053557)

HEALTHCARE PROVIDER: MITCHELL REID DOUGHERTY 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	1992053557
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3072732692
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140915000583
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DOUGHERTY
	Individual professional last name
Provider First Name	MITCHELL
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	SPORTS MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	SPORTS MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	EBERLE-REAGAN, INC
	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	4688807993
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	13396 PRESTON RD
	Group Practice or individual's line 1 address
City	DALLAS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	752405208
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9725037272
	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	M