Provider Demographics
NPI:1194920272
Name:MELLINGER CHIROPRACTIC
Entity type:Organization
Organization Name:MELLINGER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:MELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-999-5530
Mailing Address - Street 1:7023 OWENSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2006
Mailing Address - Country:US
Mailing Address - Phone:818-999-5530
Mailing Address - Fax:818-999-5532
Practice Address - Street 1:7023 OWENSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2006
Practice Address - Country:US
Practice Address - Phone:818-999-5530
Practice Address - Fax:818-999-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14148D.C.111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15362Medicare ID - Type Unspecified