Provider Demographics
NPI:1689377236
Name:MENDEZ, KEVIN JONELLE (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JONELLE
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 RANDOM HILLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7421
Mailing Address - Country:US
Mailing Address - Phone:703-373-7113
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7421
Practice Address - Country:US
Practice Address - Phone:703-373-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor