Provider Demographics
NPI:1205829660
Name:SKINDZIER GLEISS, MELANIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:SKINDZIER GLEISS
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 1:888 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1845
Mailing Address - Country:US
Mailing Address - Phone:269-637-2131
Mailing Address - Fax:269-639-8888
Practice Address - Street 1:888 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-1845
Practice Address - Country:US
Practice Address - Phone:269-637-2131
Practice Address - Fax:269-639-8888
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-07-28
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
MI2301005679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H010370OtherBCBS PROVIDER PIN
MI950H010370OtherBCBS PROVIDER PIN