Provider Demographics
NPI:1215945613
Name:MELCHERT, KEVIN (ATC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MELCHERT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-0914
Mailing Address - Country:US
Mailing Address - Phone:563-599-7910
Mailing Address - Fax:
Practice Address - Street 1:1450 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4327
Practice Address - Country:US
Practice Address - Phone:563-588-7408
Practice Address - Fax:563-557-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer