Individual
MRS. LISA MARIE JACO-MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C
Contact information
Practice address
2100 S CLARE AVE, CLARE, MI 48617-9755
(989) 386-2931
(989) 386-3509
Mailing address
2100 S CLARE AVE, CLARE, MI 48617-9755
(989) 386-2931
(989) 386-3509
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008270
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4282720
—
MI
01
—
950A850110
BLUE CROSS & BLUE SHIELD
MI
Enumeration date
12/06/2005
Last updated
12/11/2013
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