Provider Demographics
NPI:1508916032
Name:MANDELSTEIN, BRIAN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CRAIG
Last Name:MANDELSTEIN
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 1:7399 VIA LURIA
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5254
Mailing Address - Country:US
Mailing Address - Phone:561-213-2335
Mailing Address - Fax:954-987-9796
Practice Address - Street 1:2699 STIRLING ROAD
Practice Address - Street 2:SUITE C-405
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:561-213-2335
Practice Address - Fax:954-987-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor