Provider Demographics
NPI:1861630204
Name:MELZER CHIROPRACTIC GROUP, APC
Entity Type:Organization
Organization Name:MELZER CHIROPRACTIC GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MELZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-832-4476
Mailing Address - Street 1:1536 W 25TH ST # 543
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4415
Mailing Address - Country:US
Mailing Address - Phone:310-832-4476
Mailing Address - Fax:
Practice Address - Street 1:660 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3118
Practice Address - Country:US
Practice Address - Phone:310-832-4476
Practice Address - Fax:310-832-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21059111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU21621Medicare UPIN
CADC21059AMedicare PIN