Provider Demographics
NPI:1932832979
Name:MELDONIAN, MARLIN JOSEPH (DC, LMT)
Entity Type:Individual
Prefix:
First Name:MARLIN
Middle Name:JOSEPH
Last Name:MELDONIAN
Suffix:
Gender:M
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 E INDIANTOWN RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5188
Mailing Address - Country:US
Mailing Address - Phone:561-831-9606
Mailing Address - Fax:
Practice Address - Street 1:1080 E INDIANTOWN RD STE 103A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5188
Practice Address - Country:US
Practice Address - Phone:561-831-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA86116225700000X
FLCH13861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist