Provider Demographics
NPI:1194720458
Name:MANDELL, BRADLEY I (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:I
Last Name:MANDELL
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 1:3629 SUZANNE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-9318
Mailing Address - Country:US
Mailing Address - Phone:843-957-0943
Mailing Address - Fax:
Practice Address - Street 1:3629 SUZANNE DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9318
Practice Address - Country:US
Practice Address - Phone:843-957-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3020111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO64Medicare ID - Type Unspecified