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General NPI Number Information
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NPI Number | 1750018123
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Entity Type | Organization
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Legal Business Name | DR WALTER J MELLGREN JR DC PA
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 10116 SADDLE CREEK RD
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City | WACO
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State | TX
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Zip | 76708-7290
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Country | US
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Telephone | 254-836-1010
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Fax | 254-836-0177
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Provider Business Mailing Address
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Address Line | PO BOX 475
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City | WEST
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State | TX
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Zip | 76691-0475
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Country | US
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Telephone | 254-836-1010
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Fax | 254-836-0177
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MICHAEL AARON MELLGREN
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Credential | DC
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Telephone | 254-836-1010
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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 |
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License Number State |
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