Provider Demographics
NPI:1891887451
Name:MONDO, JAMES G (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:MONDO
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:1310 HIGHWAY 96 E
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3624
Mailing Address - Country:US
Mailing Address - Phone:651-429-0304
Mailing Address - Fax:651-429-8326
Practice Address - Street 1:1310 HIGHWAY 96 E
Practice Address - Street 2:SUITE #102
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3624
Practice Address - Country:US
Practice Address - Phone:651-429-0304
Practice Address - Fax:651-429-8326
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26186MOOtherBCBS
MNP39286Medicare UPIN