Provider Demographics
NPI:1184797201
Name:MENDES, VINCENT JOSEPH III (D C)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:MENDES
Suffix:III
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 EAST HIGHWAY 76
Mailing Address - Street 2:PO BOX 833
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571
Mailing Address - Country:US
Mailing Address - Phone:843-423-4263
Mailing Address - Fax:843-431-9400
Practice Address - Street 1:2516 EAST HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571
Practice Address - Country:US
Practice Address - Phone:843-423-4263
Practice Address - Fax:843-431-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2430Medicaid
SCP00059248Medicare PIN