Provider Demographics
NPI:1467558445
Name:MELBY, WILLIAM I (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:I
Last Name:MELBY
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 1:1208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1304
Mailing Address - Country:US
Mailing Address - Phone:262-878-4109
Mailing Address - Fax:
Practice Address - Street 1:1208 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1304
Practice Address - Country:US
Practice Address - Phone:262-878-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2071-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38794800Medicaid
WI75018Medicare ID - Type Unspecified