Provider Demographics
NPI:1841460110
Name:MAR, MINDY (DC)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:MAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3707
Mailing Address - Country:US
Mailing Address - Phone:619-299-1200
Mailing Address - Fax:619-299-2212
Practice Address - Street 1:2667 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 112B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3707
Practice Address - Country:US
Practice Address - Phone:619-299-1200
Practice Address - Fax:619-299-2212
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor