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General NPI Number Information
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NPI Number | 1568643294
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Entity Type | Organization
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Legal Business Name | GRANT-MELTON CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 11/22/2007
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 1351 E CALL ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2804
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Country | US
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Telephone | 850-878-2369
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Fax | 850-878-2477
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Provider Business Mailing Address
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Address Line | PO BOX 231
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City | TALLAHASSEE
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State | FL
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Zip | 32302-0231
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Country | US
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Telephone | 850-878-2369
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Fax | 850-878-2477
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Authorized Official
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Title or Position | VP
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Name | DR. WALTER CALVIN MELTON JR.
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Credential | D.C.
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Telephone | 850-878-2369
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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 | CH1072
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License Number State | FL
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