Provider Demographics
NPI:1235123266
Name:WENDELL, CHRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:WENDELL
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 1:250 EL CAMINO REAL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3655
Mailing Address - Country:US
Mailing Address - Phone:714-508-9999
Mailing Address - Fax:714-508-0462
Practice Address - Street 1:250 EL CAMINO REAL
Practice Address - Street 2:SUITE 104
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3655
Practice Address - Country:US
Practice Address - Phone:714-508-9999
Practice Address - Fax:714-508-0462
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22260111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU44724Medicare UPIN