Provider Demographics
NPI:1699246694
Name:WENDT, MONIQUE NICOLE (DC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICOLE
Last Name:WENDT
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 1:12210 SW MAIN ST # 230259
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6222
Mailing Address - Country:US
Mailing Address - Phone:657-342-9103
Mailing Address - Fax:
Practice Address - Street 1:12210 SW MAIN ST # 230259
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6222
Practice Address - Country:US
Practice Address - Phone:657-342-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor