Healthcare Provider Details

I. General information

NPI: 1942648894
Provider Name (Legal Business Name): CARL J MELVILLE II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 NORTH HIGHWAY 173
LAKE ARROWHEAD CA
92321-0716
US

IV. Provider business mailing address

PO BOX 50 PMB 343
LAKE ARROWHEAD CA
92352
US

V. Phone/Fax

Practice location:
  • Phone: 909-336-3670
  • Fax:
Mailing address:
  • Phone: 909-337-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: