Provider Demographics
NPI:1528587524
Name:THOMAS, MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:THOMAS
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 1:4150 E BELTLINE AVE NE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9316
Mailing Address - Country:US
Mailing Address - Phone:616-447-9888
Mailing Address - Fax:616-447-9886
Practice Address - Street 1:4150 E BELTLINE AVE NE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9316
Practice Address - Country:US
Practice Address - Phone:616-447-9888
Practice Address - Fax:616-447-9886
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor