Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 15749 | CA |
NPI | 1447360904 |
---|---|
Provider Name | Dr. Edward Ivins Mendenhall |
First Address | Santa Cruz, CA 95062-3363 |
Second Address | Santa Cruz, CA 95062-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |