Provider Demographics
NPI:1487849980
Name:MENDILLO, MATTHEW FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FRANK
Last Name:MENDILLO
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 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1439
Mailing Address - Country:US
Mailing Address - Phone:732-431-2155
Mailing Address - Fax:732-431-2889
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1439
Practice Address - Country:US
Practice Address - Phone:732-431-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00559111N00000X
SC3653111N00000X
NJ38MC00723600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3653OtherSC LICENSE NUMBER
NJ38MC00723600OtherNJ LICENSE NUMBER
RIDCP00559OtherR.I. LICENSE NUMBER