Provider Demographics
NPI:1518176304
Name:MNDALBY INC
Entity Type:Organization
Organization Name:MNDALBY INC
Other - Org Name:CAMAS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALBRECHTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-834-3434
Mailing Address - Street 1:732 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1665
Mailing Address - Country:US
Mailing Address - Phone:360-834-3434
Mailing Address - Fax:360-834-2637
Practice Address - Street 1:732 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1665
Practice Address - Country:US
Practice Address - Phone:360-834-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty