Provider Demographics
NPI:1215910625
Name:WILKE, MELISSA D (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:WILKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:BOROVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2075 BLACKBERRY DR STE B
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4716
Mailing Address - Country:US
Mailing Address - Phone:630-723-8983
Mailing Address - Fax:
Practice Address - Street 1:2075 BLACKBERRY DR STE B
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4716
Practice Address - Country:US
Practice Address - Phone:630-723-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0039941260OtherBLUE SHEILD
0039941260OtherBLUE SHEILD
ILK21598Medicare ID - Type Unspecified