Provider Demographics
NPI:1073561528
Name:WASKEVICH, MELANIE DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DAWN
Last Name:WASKEVICH
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 1:901 E INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5397
Mailing Address - Country:US
Mailing Address - Phone:989-835-2440
Mailing Address - Fax:989-835-2442
Practice Address - Street 1:901 E INDIAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5397
Practice Address - Country:US
Practice Address - Phone:989-835-2440
Practice Address - Fax:989-835-2442
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4718119Medicaid