Individual
DR. JACK PAUL MITCHELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1011 W LOOP 281, SUITE 9, LONGVIEW, TX 75604-2970
(903) 759-2533
Mailing address
PO BOX 9159, LONGVIEW, TX 75608-9159
(903) 759-2533
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
7317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
605821
BCBS
TX
Enumeration date
02/07/2007
Last updated
11/20/2007
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