MEDICARE: DR. TED DAVID MITCHELL SR.

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	111NR0400X	Rehabilitation Chiropractor	CH7489	FL
2	111NX0100X	Occupational Health Chiropractor	CH7489	FL

General Provider Information

NPI Number	:	1538217385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED DAVID MITCHELL SR.

Provider Business Mailing Address
First Line	:	PO BOX 56113
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32241-6113
Country	:	US
Telephone Number	:	904-636-0282
Fax Number	:	904-285-3857

Provider Business Practice Location Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 601
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-636-0282
Fax Number	:	904-285-3857

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/11/2025

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