Provider Demographics
NPI:1124146352
Name:CARDELL, VINCENT MARK (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MARK
Last Name:CARDELL
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 1:809 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3978
Mailing Address - Country:US
Mailing Address - Phone:704-482-2225
Mailing Address - Fax:704-482-2077
Practice Address - Street 1:809 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3978
Practice Address - Country:US
Practice Address - Phone:704-482-2225
Practice Address - Fax:704-482-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08362OtherBLUE CROSS BLUE SHIELD