Provider Demographics
NPI:1144386590
Name:MANDELL, C. STEVENS (DC)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:STEVENS
Last Name:MANDELL
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 1:735 JAMES ST
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-3915
Mailing Address - Country:US
Mailing Address - Phone:413-536-2225
Mailing Address - Fax:413-536-1132
Practice Address - Street 1:735 JAMES ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3915
Practice Address - Country:US
Practice Address - Phone:413-536-2225
Practice Address - Fax:413-536-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35322Medicare ID - Type UnspecifiedPROVIDER NUMBER