MEDICARE: WEST LAKE CHIROPRACTIC PC

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	111N00000X	Chiropractor	2447	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02820	OTHER	NC	BCBS GROUP #

General Provider Information

NPI Number	:	1336253558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAKE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	275 N HIGHWAY 16
Second Line	:	SUITE 102
City	:	DENVER
State	:	NC
Zip	:	28037-3000
Country	:	US
Telephone Number	:	704-489-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 N HIGHWAY 16
Second Line	:	SUITE 102
City	:	DENVER
State	:	NC
Zip	:	28037-3000
Country	:	US
Telephone Number	:	704-489-1999
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. HEATHER J MELLING
Credential	:	DC
Telephone Number	:	704-489-1999

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	12/28/2011

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Directions to “WEST LAKE CHIROPRACTIC PC ” Practice Location

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