Provider Demographics
NPI:1275738577
Name:MITCHEL V. MONDO, INC.
Entity Type:Organization
Organization Name:MITCHEL V. MONDO, INC.
Other - Org Name:TOTAL HEALTH SOLUTIONS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-429-0101
Mailing Address - Street 1:1310 HIGHWAY 96 E STE 206
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3619
Mailing Address - Country:US
Mailing Address - Phone:651-429-0101
Mailing Address - Fax:651-407-3163
Practice Address - Street 1:1310 HIGHWAY 96 E STE 206
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3619
Practice Address - Country:US
Practice Address - Phone:651-429-0101
Practice Address - Fax:651-407-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26147MOOtherBCBS
MN100154Medicare UPIN