Provider Demographics
NPI:1447497375
Name:MELVIN CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:MELVIN CHIROPRACTIC HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-923-6777
Mailing Address - Street 1:2780 E RIVERSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7489
Mailing Address - Country:US
Mailing Address - Phone:909-923-6777
Mailing Address - Fax:909-923-0774
Practice Address - Street 1:2780 E RIVERSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7489
Practice Address - Country:US
Practice Address - Phone:909-923-6777
Practice Address - Fax:909-923-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26446111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty