Provider Demographics
NPI:1407852924
Name:MELTON, TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MELTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BUFFALO GAP RD STE C1
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3363
Mailing Address - Country:US
Mailing Address - Phone:325-261-1640
Mailing Address - Fax:325-480-1267
Practice Address - Street 1:4601 BUFFALO GAP RD STE C1
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3363
Practice Address - Country:US
Practice Address - Phone:325-261-1640
Practice Address - Fax:325-480-1267
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2022-10-17
Deactivation Date:2006-06-14
Deactivation Code:
Reactivation Date:2007-01-31
Provider Licenses
StateLicense IDTaxonomies
TX8521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8285856OtherBLUE LINK
TX606299OtherBCBS
TXU85856Medicare UPIN
TX609577Medicare ID - Type Unspecified
TX606299OtherBCBS