Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC002030L | PA |
NPI | 1215049713 |
---|---|
Provider Name | Dr. Craig Tyler Mandel |
First Address | Lancaster, PA 17601-2101 |
Second Address | Lancaster, PA 17601-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T28054 | (02) | PA |