Walter Jean Mellgren Jr., DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2506 Issued in TX

Practice address

109 N Reagan St
West, TX 76691-0475

Phone

(254) 826-3737

Fax

(254) 826-3769

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richard E Davis, DC, PLLC

  • Chiropractor
  • West, TX
  • NPI 1972236057
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386675262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 475",
            "address_2": "109 N REAGAN ST",
            "city": "WEST",
            "state": "TX",
            "postal_code": "766910475",
            "telephone_number": "254-826-3737",
            "fax_number": "254-826-3769"
        },
        {
            "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": "766910475",
            "telephone_number": "254-826-3737",
            "fax_number": "254-826-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLGREN",
        "first_name": "WALTER",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "2506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00L71L",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maddison Camille Kettler
• Brent P Komlofske, ATC, LAT
• Ruth Kuloba, COTA
• Charity Martin, COTA
• Cary McLevis
• Terry Lynn Moore, MS, LPC, LCCA
• Nhci of Hillsboro Inc
• Randy James Niemeyer, PHARMD
• Kira Nunn
• Old Corner Wellness Inc

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.