Provider Demographics
NPI:1073766630
Name:MELIKIAN, MARGARITA G (DC)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:G
Last Name:MELIKIAN
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 1:1188 ROYAL GLEN DR
Mailing Address - Street 2:#211
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6099
Mailing Address - Country:US
Mailing Address - Phone:847-533-1468
Mailing Address - Fax:
Practice Address - Street 1:16W501 NIELSON LN
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-6826
Practice Address - Country:US
Practice Address - Phone:630-455-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1649004Medicare PIN
ILIL1649Medicare PIN