Healthcare Provider Details

I. General information

NPI: 1497664478
Provider Name (Legal Business Name): JESSE MINGALONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 HERITAGE GREEN WAY
BRADENTON FL
34212-1449
US

IV. Provider business mailing address

340 LAKE PALMS DR
LARGO FL
33771-2688
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-4500
  • Fax:
Mailing address:
  • Phone: 941-761-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH16102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: