Provider Demographics
NPI:1013141795
Name:MELANCON CHIROPRACTIC & WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:MELANCON CHIROPRACTIC & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-873-8586
Mailing Address - Street 1:430 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2461
Mailing Address - Country:US
Mailing Address - Phone:985-873-8586
Mailing Address - Fax:985-873-8565
Practice Address - Street 1:430 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2461
Practice Address - Country:US
Practice Address - Phone:985-873-8586
Practice Address - Fax:985-873-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAV01821Medicare UPIN
LA4H174Medicare PIN