Provider Demographics
NPI:1205035375
Name:MELODY D HEYDINGER, DC, PROF CORP
Entity Type:Organization
Organization Name:MELODY D HEYDINGER, DC, PROF CORP
Other - Org Name:SERENITY SPINAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEYDINGERDC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-932-6100
Mailing Address - Street 1:201 S KIBLER ST
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854-9771
Mailing Address - Country:US
Mailing Address - Phone:419-492-2129
Mailing Address - Fax:419-492-3344
Practice Address - Street 1:201 S KIBLER ST
Practice Address - Street 2:
Practice Address - City:NEW WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:44854-9771
Practice Address - Country:US
Practice Address - Phone:419-492-2129
Practice Address - Fax:419-492-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37589OtherMEDICARE GROUP