Provider Demographics
NPI:1003972597
Name:MELTON, WALTER CALVIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CALVIN
Last Name:MELTON
Suffix:JR
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:PO BOX 14593
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4593
Mailing Address - Country:US
Mailing Address - Phone:850-570-0208
Mailing Address - Fax:850-878-2281
Practice Address - Street 1:2056 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-570-0208
Practice Address - Fax:850-878-2281
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53947OtherBCBSFL
FLJPG001OtherVISTA
FLJPG001OtherVISTA