Provider Demographics
NPI:1922037837
Name:MELLGREN, MICHAEL AARON (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AARON
Last Name:MELLGREN
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 475
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-0475
Mailing Address - Country:US
Mailing Address - Phone:254-836-1010
Mailing Address - Fax:254-836-0177
Practice Address - Street 1:10116 SADDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7290
Practice Address - Country:US
Practice Address - Phone:254-836-1010
Practice Address - Fax:254-836-0177
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8V4820OtherBCBS OF TX IND
TX00L71LOtherBCBS OF TX GROUP
8V4820OtherBCBS OF TX IND
V09190Medicare UPIN
TX8G5677Medicare ID - Type Unspecified