MEDICARE: MELTON CHIROPRACTIC,PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	10128	TX

General Provider Information

NPI Number	:	1114024742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELTON CHIROPRACTIC,PLLC

Provider Business Mailing Address
First Line	:	879 HIGHLAND BLVD
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-3999
Country	:	US
Telephone Number	:	832-577-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	879 HIGHLAND BLVD
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-3999
Country	:	US
Telephone Number	:	832-577-8189
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	DR. CECILIA LOUISE MELTON
Credential	:	D.C.
Telephone Number	:	832-577-8189

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	10/07/2012

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