MEDICARE: MONDA T WAKED DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3621	OH

General Provider Information

NPI Number	:	1245375351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONDA T WAKED DC

Provider Business Mailing Address
First Line	:	7257 CENTER ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4907
Country	:	US
Telephone Number	:	440-205-9910
Fax Number	:	440-974-2400

Provider Business Practice Location Address
First Line	:	7249 CENTER ST STE 2
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4907
Country	:	US
Telephone Number	:	440-205-9910
Fax Number	:	440-974-2400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	02/24/2020

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Directions to “ MONDA T WAKED DC” Practice Location

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