Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | DC26845 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC26845 | CA |
NPI | 1083827166 |
---|---|
Provider Name | Dr. Mel Eugene Braxton |
First Address | Van Nuys, CA 91405-2617 |
Second Address | Culver City, CA 90232-7330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |