Individual provider Active NPI

Gerry Dewayne Mitchell, D.C.

  • Chiropractor
  • Saint James, MO
National Provider Identifier
1770716409
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2009026117 Issued in MO
Practice address
119 E Springfield St
Saint James, MO 65559-1646
Phone
(573) 265-0310
Fax
(844) 444-0939
NPI assigned
Aug 28, 2009
Last updated
Aug 18, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2009026117 MO Primary

Addresses

Primary practice location

119 E Springfield St
Saint James, MO 65559-1646

Mailing address

119 E Springfield St
Saint James, MO 65559-1646
Phone (573) 265-0310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091016000213 MO Practitioner - Chiropractic 3779620182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mitchell Clinic LLCGroup PAC ID 8123165537, 2 clinicians

Practice addresses (Care Compare)

119 E Springfield St
Saint James, MO 65559-1646
Phone (573) 265-0310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mitchell Clinic LLC Chiropractor CurrentSince Sep 2, 2009 Accepting new patients

Locations

115 E Springfield St
Ste 105
Saint James, MO 65559

119 E Springfield St
Saint James, MO 65559
Phone (573) 265-0310

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1770716409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 E SPRINGFIELD ST",
            "city": "SAINT JAMES",
            "state": "MO",
            "postal_code": "655591646",
            "telephone_number": "573-265-0310",
            "fax_number": "844-444-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 E SPRINGFIELD ST",
            "city": "SAINT JAMES",
            "state": "MO",
            "postal_code": "655591646",
            "telephone_number": "573-265-0310",
            "fax_number": "844-444-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "GERRY",
        "middle_name": "DEWAYNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-28",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009026117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint James, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.