Provider Demographics
NPI:1962418780
Name:ROTHENBERGER, MELISA A (DC)
Entity type:Individual
Prefix:DR
First Name:MELISA
Middle Name:A
Last Name:ROTHENBERGER
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 1:219 E HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-9627
Mailing Address - Country:US
Mailing Address - Phone:847-649-3422
Mailing Address - Fax:847-844-4991
Practice Address - Street 1:757 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2108
Practice Address - Country:US
Practice Address - Phone:847-649-3422
Practice Address - Fax:847-844-4991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11-3700523OtherTAX IDENTIFICATION NUMBER
IL04532141OtherBLUE CROSS BLUE SHIELD
IL207699Medicare ID - Type Unspecified
IL11-3700523OtherTAX IDENTIFICATION NUMBER