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General NPI Number Information
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NPI Number | 1336253558
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Entity Type | Organization
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Legal Business Name | WEST LAKE CHIROPRACTIC PC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 275 N HIGHWAY 16 SUITE 102
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City | DENVER
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State | NC
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Zip | 28037-3000
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Country | US
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Telephone | 704-489-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 275 N HIGHWAY 16 SUITE 102
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City | DENVER
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State | NC
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Zip | 28037-3000
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Country | US
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Telephone | 704-489-1999
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. HEATHER J MELLING
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Credential | DC
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Telephone | 704-489-1999
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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 | 2447
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License Number State | NC
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