Provider Demographics
NPI:1841320264
Name:KALLSEN, MELVIN HENRY JR (D C)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:HENRY
Last Name:KALLSEN
Suffix:JR
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MEEKER ST
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2321
Mailing Address - Country:US
Mailing Address - Phone:970-867-8001
Mailing Address - Fax:970-867-1969
Practice Address - Street 1:316 MEEKER ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2321
Practice Address - Country:US
Practice Address - Phone:970-867-8001
Practice Address - Fax:970-867-1969
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2023OtherSTATE BOARD LICENSE NUMBE
CO22823Medicare UPIN