Provider Demographics
NPI:1134289689
Name:MELL CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:MELL CHIROPRACTIC CLINIC P.C.
Other - Org Name:DR H ALLAN MELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-726-6355
Mailing Address - Street 1:1159 E LAKETON AVE
Mailing Address - Street 2:NONE
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:NONE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF15O29OtherBCBS
MIOF15O29OtherBCBS
MIOF15029Medicare ID - Type Unspecified