Provider Demographics
NPI:1215049713
Name:MANDEL, CRAIG TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:TYLER
Last Name:MANDEL
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 1:2827 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2101
Mailing Address - Country:US
Mailing Address - Phone:717-898-2400
Mailing Address - Fax:717-898-7543
Practice Address - Street 1:2827 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2101
Practice Address - Country:US
Practice Address - Phone:717-898-2400
Practice Address - Fax:717-898-7543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002030L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28054Medicare UPIN
PA063156Medicare ID - Type Unspecified