Provider Demographics
NPI:1003988361
Name:MELL, HENRY ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALLAN
Last Name:MELL
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 1:1159 E LAKETON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-6024
Mailing Address - Country:US
Mailing Address - Phone:231-726-6355
Mailing Address - Fax:231-725-8300
Practice Address - Street 1:1159 E LAKETON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6024
Practice Address - Country:US
Practice Address - Phone:231-726-6355
Practice Address - Fax:231-725-8300
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F15029OtherBCBS
MIHM004789Medicare UPIN
MI0F15029Medicare ID - Type Unspecified