Provider Demographics
NPI:1083827166
Name:BRAXTON, MEL EUGENE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:EUGENE
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13822 WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2617
Mailing Address - Country:US
Mailing Address - Phone:818-652-5586
Mailing Address - Fax:
Practice Address - Street 1:5835 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-7330
Practice Address - Country:US
Practice Address - Phone:323-857-0800
Practice Address - Fax:323-939-7951
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26845111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 26845Medicare ID - Type UnspecifiedCHIROPRACTOR