Provider Demographics
NPI:1659395549
Name:MELKONIAN, LEON S (DC)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:S
Last Name:MELKONIAN
Suffix:
Gender:M
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:PO BOX 2687
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-2687
Mailing Address - Country:US
Mailing Address - Phone:714-438-1190
Mailing Address - Fax:714-438-1191
Practice Address - Street 1:1700 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-438-1190
Practice Address - Fax:714-438-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0915380Medicare UPIN
CADC20311BMedicare UPIN