Provider Demographics
NPI:1033247382
Name:MELLINGER, LARRY DALE (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DALE
Last Name:MELLINGER
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2508
Mailing Address - Country:US
Mailing Address - Phone:626-357-3232
Mailing Address - Fax:626-357-6068
Practice Address - Street 1:228 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2508
Practice Address - Country:US
Practice Address - Phone:626-357-3232
Practice Address - Fax:626-357-6068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11480111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17098Medicare UPIN
CADC11480Medicare ID - Type Unspecified