Provider Demographics
NPI:1326484718
Name:MELLMAN CHIROPRACTIC GROUP PA
Entity Type:Organization
Organization Name:MELLMAN CHIROPRACTIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-412-5914
Mailing Address - Street 1:4263 SW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3461
Mailing Address - Country:US
Mailing Address - Phone:954-457-8788
Mailing Address - Fax:954-457-9588
Practice Address - Street 1:4263 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3461
Practice Address - Country:US
Practice Address - Phone:954-457-8788
Practice Address - Fax:954-457-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8735111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty