Healthcare Provider Details

I. General information

NPI: 1063599421
Provider Name (Legal Business Name): MELLIN CHIROPRACTIC CARE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 EDINBOROUGH WAY SUITE 108
EDINA MN
55435-5923
US

IV. Provider business mailing address

3300 EDINBOROUGH WAY SUITE 108
EDINA MN
55435-5923
US

V. Phone/Fax

Practice location:
  • Phone: 952-921-0333
  • Fax: 952-832-0766
Mailing address:
  • Phone: 952-921-0333
  • Fax: 952-832-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number614
License Number StateMN

VIII. Authorized Official

Name: JAMES P. MELLIN II
Title or Position: OWNER
Credential: D.C.
Phone: 952-921-0333