Provider Demographics
NPI:1902272180
Name:MANDAHLA MEDICAL
Entity Type:Organization
Organization Name:MANDAHLA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:702-286-6354
Mailing Address - Street 1:1200 WESTLAKE AVE N
Mailing Address - Street 2:STE 604
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3543
Mailing Address - Country:US
Mailing Address - Phone:206-946-9944
Mailing Address - Fax:
Practice Address - Street 1:1200 WESTLAKE AVE N
Practice Address - Street 2:STE 604
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3543
Practice Address - Country:US
Practice Address - Phone:206-946-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X, 172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty