Provider Demographics
NPI:1902396096
Name:NEMETH, MANDY (DC)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:
Last Name:NEMETH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:LOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:88 NOBLE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4738
Mailing Address - Country:US
Mailing Address - Phone:203-283-5404
Mailing Address - Fax:203-283-5405
Practice Address - Street 1:88 NOBLE AVE STE 106
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4738
Practice Address - Country:US
Practice Address - Phone:203-283-5404
Practice Address - Fax:203-283-5405
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor