Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301004789 | MI |
NPI | 1003988361 |
---|---|
Provider Name | Dr. Henry Allan Mell |
First Address | Muskegon, MI 49442-6024 |
Second Address | Muskegon, MI 49442-6024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0F15029 | BCBS (01) | MI |
HM004789 | (02) | MI |