# MELLOR CHIROPRACTIC CLINIC P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871602987
- **Authorized official:** STEPHEN PAUL MELLOR D.C. (CHIROPRACTIC PHYSICIAN)
- **Authorized official phone:** (208) 356-6009

## Contact information

- **Practice address:** 54 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
- **Practice address phone:** (208) 356-6009
- **Mailing address:** 54 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
- **Mailing address phone:** (208) 356-6009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | C343 | ID | Yes |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 02/06/2009