Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3020 | SC |
NPI | 1194720458 |
---|---|
Provider Name | Bradley I Mandell |
First Address | Little River, SC 29566-9318 |
Second Address | Little River, SC 29566-9318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 19/09/2019 |