Provider Demographics
NPI:1174020119
Name:MELENDEZ NEGRON, WILMER LUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:WILMER
Middle Name:LUIS
Last Name:MELENDEZ NEGRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3012
Mailing Address - Country:US
Mailing Address - Phone:787-231-9079
Mailing Address - Fax:
Practice Address - Street 1:1041 STERLING RD STE 101
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3841
Practice Address - Country:US
Practice Address - Phone:703-481-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010044111NS0005X
VA0104557601111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician