Provider Demographics
NPI:1447360904
Name:MENDENHALL, EDWARD IVINS (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:IVINS
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3363
Mailing Address - Country:US
Mailing Address - Phone:831-458-9398
Mailing Address - Fax:831-426-6159
Practice Address - Street 1:545 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-3363
Practice Address - Country:US
Practice Address - Phone:831-458-9398
Practice Address - Fax:831-426-6159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15749111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic