Dr Walter J Mellgren Jr DC PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

DR WALTER J MELLGREN JR DC PA

Practice address

109 N Reagan St
West, TX 76691-1446

Phone

(254) 826-3737

Fax

(254) 826-3769

NPI assigned

Jan 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Aaron Mellgren, DCNPI 1922037837

Title

Owner/President

Phone

(254) 826-3737

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mellgren Chiropractic Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Dr Walter J Mellgren Jr DC PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr Walter J Mellgren Jr DC PA

  • Chiropractor
  • Waco, TX
  • NPI 1750018123
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Aaron Mellgren, DC

  • Chiropractor
  • Waco, TX
  • NPI 1922037837
  Medicare reassignment NPD Authorized official
• Richard Elton Davis, DC

  • Chiropractor
  • West, TX
  • NPI 1215553318
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1154467934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 475",
            "city": "WEST",
            "state": "TX",
            "postal_code": "766910475",
            "telephone_number": "254-826-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N REAGAN ST",
            "city": "WEST",
            "state": "TX",
            "postal_code": "766911446",
            "telephone_number": "254-826-3737",
            "fax_number": "254-826-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR WALTER J MELLGREN JR DC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "MELLGREN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "254-826-3737",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUESHIELD OF TEXAS",
            "identifier": "00L71L",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mellgren Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mellgren Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ann Marie Dennis, M. ED, LPC
• Generation RX Inc.
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• Tina Denise Green, LCSW
• Hannah Morgan Grigsby
• Valerie R Grimm

• Chiropractor in West, TX
• Providers in West, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.