Provider Demographics
NPI:1093958969
Name:CANNADY, MELANIE RAE (DC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RAE
Last Name:CANNADY
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 1:3175 BROMLEY LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-6520
Mailing Address - Country:US
Mailing Address - Phone:312-685-9095
Mailing Address - Fax:
Practice Address - Street 1:3175 BROMLEY LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6520
Practice Address - Country:US
Practice Address - Phone:312-685-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor