Provider Demographics
NPI:1508223694
Name:MELBOURNE ACCIDENT & INJURY CENTER, INC.
Entity Type:Organization
Organization Name:MELBOURNE ACCIDENT & INJURY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:TRASTELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-622-6610
Mailing Address - Street 1:6284 PARADISE ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6962
Mailing Address - Country:US
Mailing Address - Phone:321-622-6610
Mailing Address - Fax:
Practice Address - Street 1:2351 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3114
Practice Address - Country:US
Practice Address - Phone:321-622-6610
Practice Address - Fax:321-622-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty