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General NPI Number Information
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NPI Number | 1104363308
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Entity Type | Organization
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Legal Business Name | MINK CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 601 S B ST SUITE B
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City | SAN MATEO
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State | CA
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Zip | 94401-4120
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Country | US
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Telephone | 650-421-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S B ST SUITE B
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City | SAN MATEO
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State | CA
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Zip | 94401-4120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE MINK
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Credential |
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Telephone | 650-425-7723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 29900
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License Number State | CA
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