MEDICARE: DR. PERRY BURTON MITCHELL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4100	TX

General Provider Information

NPI Number	:	1427156793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY BURTON MITCHELL D.C.

Provider Business Mailing Address
First Line	:	9179 GRISSOM RD STE 131
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-680-5133
Fax Number	:	210-680-4772

Provider Business Practice Location Address
First Line	:	9179 GRISSOM RD STE 131
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-680-5133
Fax Number	:	210-680-4772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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