Provider Demographics
NPI:1053182915
Name:TRUJILLO, MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MICHELL
Other - Middle Name:
Other - Last Name:GRIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 HARVESTER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7459
Mailing Address - Country:US
Mailing Address - Phone:858-220-1507
Mailing Address - Fax:
Practice Address - Street 1:1833 MARKETPLACE DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8506
Practice Address - Country:US
Practice Address - Phone:858-220-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor