Gary Douglas Mellum, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1039 Issued in ND

Practice address

5621 36TH Ave S
Suite 200
Fargo, ND 58104-5269

Phone

(701) 429-7001

NPI assigned

Jul 24, 2012

Last updated

May 8, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Northstar Chiropractic

  • Chiropractor
  • Fargo, ND
  • NPI 1053850552
  Authorized official Same address or phone
• Nordic Family Medicine PC

  • Family Medicine Physician
  • Fargo, ND
  • NPI 1679201578
  NPD
• Complete Care Chiropractic KC, LLC

  • Chiropractor
  • Olathe, KS
  • NPI 1104378223
  NPD (past)

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1750637013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5621 36TH AVE S",
            "address_2": "SUITE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045269",
            "telephone_number": "701-429-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5621 36TH AVE S",
            "address_2": "SUITE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045269",
            "telephone_number": "701-429-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLUM",
        "first_name": "GARY",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-24",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "1039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret A Melgard, RN PAC
• Maria Louise-Hills Melichar, NURSE PRACTITIONER
• Kevin Lyle Melicher, OD
• Paul R Melicher, O.D.
• Melinda Harr, DDS, PC
• Stephanie Janine Melquist, MD, MPH
• Dyan P Melton, RN
• Daniel Lawrence Mengedoth, DDS
• Laura Mennenga
• Dennis Nana Asah Mensah, MD

• Chiropractor in Fargo, ND
• Providers in Fargo, ND by specialty
• Chiropractor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; 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.