Provider Demographics
NPI:1104363308
Name:MINK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MINK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-425-7723
Mailing Address - Street 1:601 S B ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S B ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4120
Practice Address - Country:US
Practice Address - Phone:650-421-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty