Provider Demographics
NPI:1528069770
Name:MELANCON, RICKY CHARLES (DC)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:CHARLES
Last Name:MELANCON
Suffix:
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 1:430 CORPORATE DR.
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-873-8586
Mailing Address - Fax:985-873-8565
Practice Address - Street 1:430 CORPORATE DR.
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-873-8586
Practice Address - Fax:985-873-8565
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA250537Medicare PIN
LAV01821Medicare UPIN