Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104557601 | VA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR010044 | GA |
NPI | 1174020119 |
---|---|
Provider Name | Dr. Wilmer Luis Melendez Negron |
First Address | Purcellville, VA 20132-3012 |
Second Address | Herndon, VA 20170-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 15/07/2021 |