Provider Demographics
NPI:1790781581
Name:ALDRIDGE, MELVIN C JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:C
Last Name:ALDRIDGE
Suffix:JR
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 5238
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5238
Mailing Address - Country:US
Mailing Address - Phone:281-991-7676
Mailing Address - Fax:281-991-7617
Practice Address - Street 1:6733 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4403
Practice Address - Country:US
Practice Address - Phone:281-991-7676
Practice Address - Fax:281-991-7617
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-11-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TX2714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601007Medicare ID - Type Unspecified
TXT11903Medicare UPIN