Provider Demographics
NPI:1740311315
Name:MELLMAN, LEON D (BS,DC)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:D
Last Name:MELLMAN
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 GOLDEN BEACH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2228
Mailing Address - Country:US
Mailing Address - Phone:786-412-5914
Mailing Address - Fax:954-457-9588
Practice Address - Street 1:685 GOLDEN BEACH DR
Practice Address - Street 2:
Practice Address - City:GOLDEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2228
Practice Address - Country:US
Practice Address - Phone:786-412-5914
Practice Address - Fax:954-457-9588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8735111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician