Provider Demographics
NPI:1750596706
Name:MELLOW, ALICE J
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:J
Last Name:MELLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 WILLOW POND CT E
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8243
Mailing Address - Country:US
Mailing Address - Phone:561-346-1663
Mailing Address - Fax:954-481-9641
Practice Address - Street 1:4541 WILLOW POND CT E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8243
Practice Address - Country:US
Practice Address - Phone:561-346-1663
Practice Address - Fax:954-481-9641
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88919AOtherBLUE CROSS
FLT56018Medicare UPIN
FL88919Medicare ID - Type UnspecifiedMEDICARE #