Provider Demographics
NPI:1487653580
Name:MELMAN CHIROPRACTIC GROUP, P.C.
Entity Type:Organization
Organization Name:MELMAN CHIROPRACTIC GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-421-1881
Mailing Address - Street 1:667 BOYLSTON ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4809
Mailing Address - Country:US
Mailing Address - Phone:617-421-1881
Mailing Address - Fax:617-236-0359
Practice Address - Street 1:667 BOYLSTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4809
Practice Address - Country:US
Practice Address - Phone:617-421-1881
Practice Address - Fax:617-236-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39533OtherBLUECROSS BLUESHIELD
MA690344OtherTUFTS
MAY49058Medicare ID - Type UnspecifiedMEDICARE