Provider Demographics
NPI:1518185420
Name:BACH, MELODY (DC)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:BACH
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 1:57 WOODLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2807
Mailing Address - Country:US
Mailing Address - Phone:914-693-7101
Mailing Address - Fax:
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2112
Practice Address - Country:US
Practice Address - Phone:914-693-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004322-1111N00000X
FLCH8657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP691181OtherOXFORD HEALTH PIN
NYX004322-1OtherCHIROPRACTIC LIC #
FLCH8657OtherCHIROPRACTIC LIC #
NYX34921Medicare ID - Type Unspecified