Provider Demographics
NPI:1487800355
Name:FINE, MITCHEL LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:LAWRENCE
Last Name:FINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N. FERNCREEK AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4870
Mailing Address - Country:US
Mailing Address - Phone:407-898-6622
Mailing Address - Fax:407-897-6268
Practice Address - Street 1:629 N. FERNCREEK AVENUE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4870
Practice Address - Country:US
Practice Address - Phone:407-898-6622
Practice Address - Fax:407-897-6268
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70561AMedicare PIN