Provider Demographics
NPI:1417051897
Name:MANDEL, DONALD R (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:MANDEL
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 1:2470 MCKNIGHT RD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2236
Mailing Address - Country:US
Mailing Address - Phone:651-777-3877
Mailing Address - Fax:651-773-0708
Practice Address - Street 1:2470 MCKNIGHT ROAD N
Practice Address - Street 2:
Practice Address - City:NORTH ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109
Practice Address - Country:US
Practice Address - Phone:651-777-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor