MEDICARE: DR. MARK ANTHONY VELLAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2101	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578669651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANTHONY VELLAN D.C.

Provider Business Mailing Address
First Line	:	3750 S. EVANS ST
Second Line	:	STE C
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-355-1770
Fax Number	:	252-353-1415

Provider Business Practice Location Address
First Line	:	3750 S. EVANS ST
Second Line	:	STE C
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-355-1770
Fax Number	:	252-353-1415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/22/2008

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