Healthcare Provider Details

I. General information

NPI: 1114024742
Provider Name (Legal Business Name): MELTON CHIROPRACTIC,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 HIGHLAND BLVD
CANYON LAKE TX
78133-3999
US

IV. Provider business mailing address

879 HIGHLAND BLVD
CANYON LAKE TX
78133-3999
US

V. Phone/Fax

Practice location:
  • Phone: 832-577-8189
  • Fax:
Mailing address:
  • Phone: 832-577-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number10128
License Number StateTX

VIII. Authorized Official

Name: DR. CECILIA LOUISE MELTON
Title or Position: OWNER, PRESIDENT
Credential: D.C.
Phone: 832-577-8189