Provider Demographics
NPI:1164506580
Name:KATIN, MELANIE (DACM, LAC)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:KATIN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 FOREST AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5524
Mailing Address - Country:US
Mailing Address - Phone:917-449-5038
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 701
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6031
Practice Address - Country:US
Practice Address - Phone:917-449-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001356171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist