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General NPI Number Information
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NPI Number | 1710483052
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Entity Type | Individual
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Provider Name | MARIO JOSEPH MANDESE D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 2254 FLORIDA HIGHWAY A1A
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-5919
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Country | US
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Telephone | 321-626-0994
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Fax | 321-420-1762
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Provider Business Mailing Address
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Address Line | 2254 FLORIDA HIGHWAY A1A
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-5919
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Country | US
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Telephone | 321-626-0994
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Fax | 321-420-1762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH12442
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License Number State | FL
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