=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750596706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ALICE J MELLOW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4541 WILLOW POND CT E
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33417-8243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-346-1663
-----------------------------------------------------
Fax | 954-481-9641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4541 WILLOW POND CT E
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33417-8243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-346-1663
-----------------------------------------------------
Fax | 954-481-9641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0004029
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------