Provider Demographics
NPI:1245660091
Name:MENDAKE, TIRTHA (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:TIRTHA
Middle Name:
Last Name:MENDAKE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 DE HARO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2708
Mailing Address - Country:US
Mailing Address - Phone:415-578-8781
Mailing Address - Fax:
Practice Address - Street 1:350 TOWNSEND ST STE 275
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1600
Practice Address - Country:US
Practice Address - Phone:415-578-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31601111NN1001X
CAAC15613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111NN1001XChiropractic ProvidersChiropractorNutrition