Provider Demographics
NPI:1558392084
Name:MENDONCA, KENDELL A (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDELL
Middle Name:A
Last Name:MENDONCA
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 1:1699 E PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2344
Mailing Address - Country:US
Mailing Address - Phone:559-686-2600
Mailing Address - Fax:559-686-7118
Practice Address - Street 1:1699 E PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2344
Practice Address - Country:US
Practice Address - Phone:559-686-2600
Practice Address - Fax:559-686-7118
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR77-0289025OtherTAX ID NUMBER
CADC0200840Medicare ID - Type Unspecified