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General NPI Number Information
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NPI Number | 1275678880
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE GROUP INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 388 MARKET ST SUITE 100
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-5311
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Country | US
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Telephone | 415-982-2273
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Fax | 415-982-2282
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Provider Business Mailing Address
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Address Line | 388 MARKET ST SUITE 100
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-5312
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Country | US
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Telephone | 415-982-2273
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Fax | 415-982-2282
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Authorized Official
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Title or Position | DOCTOR
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Name | IVAN DAVID MELEAN
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Credential | DC
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Telephone | 415-782-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC25753
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC26102
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License Number State | CA
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