Provider Demographics
NPI:1629214770
Name:ROMAN, MELINDA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 BALFOUR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1582
Mailing Address - Country:US
Mailing Address - Phone:925-308-7575
Mailing Address - Fax:925-240-7878
Practice Address - Street 1:4550 BALFOUR RD
Practice Address - Street 2:SUITE D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1582
Practice Address - Country:US
Practice Address - Phone:925-308-7575
Practice Address - Fax:925-240-7878
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor