Provider Demographics
NPI:1215044730
Name:MELVIN, TODD WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:MELVIN
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 1:521 E MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1462
Mailing Address - Country:US
Mailing Address - Phone:319-209-2115
Mailing Address - Fax:319-209-2117
Practice Address - Street 1:521 E MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1462
Practice Address - Country:US
Practice Address - Phone:319-209-2115
Practice Address - Fax:319-209-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38654OtherWELLMARK BC/BS
IAP00249894OtherRAILROAD MEDICARE
IA0457515Medicaid
IAI15440Medicare ID - Type Unspecified
IAU73903Medicare UPIN