Provider Demographics
NPI:1114098480
Name:MENDOZA, RUMMEL G (DC)
Entity Type:Individual
Prefix:DR
First Name:RUMMEL
Middle Name:G
Last Name:MENDOZA
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 1:591 SUMMIT AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2703
Mailing Address - Country:US
Mailing Address - Phone:201-963-0200
Mailing Address - Fax:201-222-1364
Practice Address - Street 1:591 SUMMIT AVE STE 415
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2703
Practice Address - Country:US
Practice Address - Phone:201-963-0200
Practice Address - Fax:201-222-1364
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010912-1111N00000X
NJ38MC00704200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor