Provider Demographics
NPI:1295950905
Name:MANTELL, ELLIOTT JOEL (DC)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:JOEL
Last Name:MANTELL
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 1:2927 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3248
Mailing Address - Country:US
Mailing Address - Phone:503-232-4099
Mailing Address - Fax:
Practice Address - Street 1:2927 NE EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3248
Practice Address - Country:US
Practice Address - Phone:503-232-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor