=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699815969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA LILLIAN MORGAN DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13911 RIDGEDALE DR SUITE 255
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55305-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-545-3839
-----------------------------------------------------
Fax | 952-546-0168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 18TH AVE N
-----------------------------------------------------
City | HOPKINS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55343-6909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-239-7320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 4554
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------