Provider Demographics
NPI:1487789053
Name:MELAHN, MICHLENE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHLENE
Middle Name:
Last Name:MELAHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 STEWARD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6501
Mailing Address - Country:US
Mailing Address - Phone:815-260-5076
Mailing Address - Fax:484-493-3162
Practice Address - Street 1:7178 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-1695
Practice Address - Country:US
Practice Address - Phone:815-260-5076
Practice Address - Fax:484-493-3162
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009269OtherSTATE LICENSE