Provider Demographics
NPI:1932135894
Name:MELLON, GREGORY K (DC,DABCO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:K
Last Name:MELLON
Suffix:
Gender:M
Credentials:DC,DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 CASTLETON WAY
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1301
Mailing Address - Country:US
Mailing Address - Phone:740-363-3330
Mailing Address - Fax:740-369-2124
Practice Address - Street 1:1802 CASTLETON WAY
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1301
Practice Address - Country:US
Practice Address - Phone:740-363-3330
Practice Address - Fax:740-369-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1000111N00000X
MI2933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311187277OtherFIN
OHME0565371Medicare PIN
OH311187277OtherFIN