Healthcare Provider Details

I. General information

NPI: 1326484718
Provider Name (Legal Business Name): MELLMAN CHIROPRACTIC GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 SW 64TH AVE
DAVIE FL
33314-3461
US

IV. Provider business mailing address

4263 SW 64TH AVE
DAVIE FL
33314-3461
US

V. Phone/Fax

Practice location:
  • Phone: 954-457-8788
  • Fax: 954-457-9588
Mailing address:
  • Phone: 954-457-8788
  • Fax: 954-457-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH8735
License Number StateFL

VIII. Authorized Official

Name: DR. LEON D MELLMAN
Title or Position: OWNER
Credential: D.C.
Phone: 786-412-5914