Provider Demographics
NPI:1124109111
Name:MELVIN, WILLIAM JR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MELVIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4221
Mailing Address - Country:US
Mailing Address - Phone:740-353-5874
Mailing Address - Fax:740-353-5896
Practice Address - Street 1:1428 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4221
Practice Address - Country:US
Practice Address - Phone:740-353-5874
Practice Address - Fax:740-353-5896
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000494743OtherANTHEM BLUE CROSS BLUE SH
OH11652526OtherCAQH UNIVERSAL CREDENTIAL
OH2740482OtherUNITED HEALTH CARE
OH2079067Medicaid
OH311548034-00OtherBUREAU OF WORKERS COMP
OHU74867Medicare UPIN
OH2740482OtherUNITED HEALTH CARE
OHP00343553Medicare ID - Type UnspecifiedRAILROAD MEDICARE