Provider Demographics
NPI:1750422937
Name:MINDEL, SCOTT (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MINDEL
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 1:2609 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1517
Mailing Address - Country:US
Mailing Address - Phone:206-441-7984
Mailing Address - Fax:206-728-1230
Practice Address - Street 1:2606 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1214
Practice Address - Country:US
Practice Address - Phone:206-441-7984
Practice Address - Fax:206-728-1230
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA025202OtherLISCENSE
WA861156360OtherTAX ID
WA861156360OtherTAX ID
WA025202OtherLISCENSE