Provider Demographics
NPI:1760723282
Name:MELLERT FAMILY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:MELLERT FAMILY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MELLERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-894-1332
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0912
Mailing Address - Country:US
Mailing Address - Phone:423-894-1332
Mailing Address - Fax:423-894-5797
Practice Address - Street 1:5706 MAIN ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8713
Practice Address - Country:US
Practice Address - Phone:423-894-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU69431Medicare UPIN
TN3679243Medicare PIN