Clark Mandel

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

205570 Issued in KY

Practice address

3650 Boston Rd Ste 188
Lexington, KY 40514-1502

Phone

(859) 263-2774

Fax

(859) 263-2787

NPI assigned

Dec 1, 2014

Last updated

Nov 24, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgetown Integrated Medicine PSC

  • Adult Medicine Physician
  • Georgetown, KY
  • NPI 1346640208
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1851798292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 BOSTON RD STE 188",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405141502",
            "telephone_number": "859-263-2774",
            "fax_number": "502-867-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 BOSTON RD STE 188",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405141502",
            "telephone_number": "859-263-2774",
            "fax_number": "859-263-2787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3221 Putter Ln",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405091982",
            "country_code": "US",
            "telephone_number": "859-619-7680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "CLARK",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-01",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "4345",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "205570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Management Systems of Ky LLC
• Anthony Mancuso II, DO
• Nicholas Mancuso, MD
• Samantha Anne Mancuso, DNP, APRN, AGACNP-BC
• Anjana Mandal
• Andrea Mandeville
• Martin Joseph Mangan III, MD
• Stephanie Gabrielle Mangan, MRC, LPCC
• Rebecca Jo Manges, OPT
• Steven Joseph Mangine, PH.D.

• Chiropractor in Lexington, KY
• Providers in Lexington, KY by specialty
• Chiropractor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.