MEDICARE: DR. CHRISTOPHER JOSEPH MENDOLA 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	7026	AZ
2	111N00000X	Chiropractor	4757	NJ
3	111N00000X	Chiropractor	F10000388	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0936150	OTHER	AZ	BC/BS

General Provider Information

NPI Number	:	1942294913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOSEPH MENDOLA DC

Provider Business Mailing Address
First Line	:	7333 W THOMAS RD
Second Line	:	STE 40
City	:	PHOENIX
State	:	AZ
Zip	:	85033-5546
Country	:	US
Telephone Number	:	623-849-1736
Fax Number	:	623-849-0406

Provider Business Practice Location Address
First Line	:	7333 W THOMAS RD
Second Line	:	STE 40
City	:	PHOENIX
State	:	AZ
Zip	:	85033-5546
Country	:	US
Telephone Number	:	623-849-1736
Fax Number	:	623-849-0406

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	10/29/2008

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