Provider Demographics
NPI:1518151299
Name:MENDENHALL, GABRIEL MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:MICHAEL
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:MICHAEL
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 STATE ROUTE 3
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9368
Mailing Address - Country:US
Mailing Address - Phone:740-965-4301
Mailing Address - Fax:740-965-5182
Practice Address - Street 1:123 STATE ROUTE 3
Practice Address - Street 2:SUITE A
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9368
Practice Address - Country:US
Practice Address - Phone:740-965-4301
Practice Address - Fax:740-965-5182
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4274651Medicare PIN