Provider Demographics
NPI:1497989602
Name:DOCKTER, MELANIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2553 KIRSTEN LN S
Mailing Address - Street 2:STE 207
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4901
Mailing Address - Country:US
Mailing Address - Phone:701-730-3867
Mailing Address - Fax:701-356-2992
Practice Address - Street 1:2553 KIRSTEN LN S
Practice Address - Street 2:SUITE 207
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4901
Practice Address - Country:US
Practice Address - Phone:701-730-3867
Practice Address - Fax:701-356-2992
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5210111N00000X
ND910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor