Provider Demographics
NPI:1154467934
Name:DR WALTER J MELLGREN JR DC PA
Entity Type:Organization
Organization Name:DR WALTER J MELLGREN JR DC PA
Other - Org Name:MELLGREN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MELLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-826-3737
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-0475
Mailing Address - Country:US
Mailing Address - Phone:254-826-3737
Mailing Address - Fax:
Practice Address - Street 1:109 N REAGAN ST
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1446
Practice Address - Country:US
Practice Address - Phone:254-826-3737
Practice Address - Fax:254-826-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L71LOtherBLUE CROSS BLUESHIELD OF TEXAS