MEDICARE: DR. PETER JAMES MELLON DC

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	S01555	MD
2	111N00000X	Chiropractor	2301005807	MI

General Provider Information

NPI Number	:	1679665624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JAMES MELLON DC

Provider Business Mailing Address
First Line	:	13002 PENN SHOP ROAD
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4566
Country	:	US
Telephone Number	:	301-831-5444
Fax Number	:	301-829-5729

Provider Business Practice Location Address
First Line	:	13002 PENN SHOP ROAD
Second Line	:
City	:	MT AIRY
State	:	MD
Zip	:	21771
Country	:	US
Telephone Number	:	301-831-5444
Fax Number	:	301-829-5729

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/28/2010

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Directions to “ DR. PETER JAMES MELLON DC” Practice Location

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