Provider Demographics
NPI:1629155932
Name:MELLIN, JAMES II (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MELLIN
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-921-0333
Mailing Address - Fax:952-832-0766
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-921-0333
Practice Address - Fax:952-832-0766
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2794111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C879MEOtherBCBS OF MN
MN4C879MEOtherBCBS OF MN