Provider Demographics
NPI:1407987712
Name:MELVIN, ROD DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:ROD
Middle Name:DAVID
Last Name:MELVIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROD
Other - Middle Name:DAVID
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2780 E RIVERSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7489
Mailing Address - Country:US
Mailing Address - Phone:909-923-6777
Mailing Address - Fax:909-923-0774
Practice Address - Street 1:2780 E RIVERSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7489
Practice Address - Country:US
Practice Address - Phone:909-923-6777
Practice Address - Fax:909-923-0774
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor