Provider Demographics
NPI:1063599421
Name:MELLIN CHIROPRACTIC CARE CLINIC, P.C.
Entity type:Organization
Organization Name:MELLIN CHIROPRACTIC CARE CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELLIN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:952-921-0333
Mailing Address - Street 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-921-0333
Mailing Address - Fax:952-832-0766
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-921-0333
Practice Address - Fax:952-832-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C878MEOtherBLUE CROSS OF MN
MNT92073Medicare UPIN