Provider Demographics
NPI:1093842742
Name:MENDELSON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MENDELSON CHIROPRACTIC LLC
Other - Org Name:TALCOTT FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-269-3228
Mailing Address - Street 1:74 PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-269-3228
Mailing Address - Fax:860-269-3229
Practice Address - Street 1:74 PARK ROAD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-269-3228
Practice Address - Fax:860-269-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1898111N00000X
CT1740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA771717OtherTUFTS HEALTH
MA1613545Medicaid
MA351175OtherHARVARD PILGRIM
MA771717OtherGIC
MAY36408OtherBCBS
CT1613545Medicaid
MA771717OtherGIC INDEMNITY
MA5283290OtherAETNA INDEMNITY