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General NPI Number Information
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NPI Number | 1811030778
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Entity Type | Organization
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Legal Business Name | LEO JOHN MELTVEDT JR DC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 4202 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-2516
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Country | US
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Telephone | 619-521-3151
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Fax | 619-516-3846
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Provider Business Mailing Address
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Address Line | 4202 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-2516
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Country | US
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Telephone | 619-521-3151
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Fax | 619-516-3846
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. LEO JOHN MELTVEDT JR.
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Credential | D.C.
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Telephone | 619-521-3151
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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 | DC26574
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License Number State | CA
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