Provider Demographics
NPI:1376585141
Name:MERGENTHALER, MELODY D (DC)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:D
Last Name:MERGENTHALER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:D
Other - Last Name:HEYDINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854-0325
Mailing Address - Country:US
Mailing Address - Phone:419-492-2129
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB878111N00000X
OH3126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37590Medicare ID - Type Unspecified
NVU94214Medicare UPIN