Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH8122 | FL |
NPI | 1003972597 |
---|---|
Provider Name | Dr. Walter Calvin Melton JR. |
First Address | Tallahassee, FL 32317-4593 |
Second Address | Tallahassee, FL 32308-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53947 | BCBSFL (01) | FL |
JPG001 | VISTA (01) | FL |
U85245-0001 | (02) | FL |