Provider Demographics
NPI:1821318056
Name:MELL, GEOFFREY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:JOSEPH
Last Name:MELL
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 1:126 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55921-1109
Mailing Address - Country:US
Mailing Address - Phone:507-725-8500
Mailing Address - Fax:507-725-8501
Practice Address - Street 1:126 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-1109
Practice Address - Country:US
Practice Address - Phone:507-725-8500
Practice Address - Fax:507-725-8501
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor