Healthcare Provider Details

I. General information

NPI: 1447360904
Provider Name (Legal Business Name): EDWARD IVINS MENDENHALL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OCEAN VIEW AVE
SANTA CRUZ CA
95062-3363
US

IV. Provider business mailing address

545 OCEAN VIEW AVE
SANTA CRUZ CA
95062-3363
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-9398
  • Fax: 831-426-6159
Mailing address:
  • Phone: 831-458-9398
  • Fax: 831-426-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number15749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: