Provider Demographics
NPI:1578645370
Name:OVERLEY, MELANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:OVERLEY
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 1:627 NW NORTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAUKOMIS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1449
Mailing Address - Country:US
Mailing Address - Phone:913-827-7063
Mailing Address - Fax:
Practice Address - Street 1:627 NW NORTH SHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE WAUKOMIS
Practice Address - State:MO
Practice Address - Zip Code:64151-1449
Practice Address - Country:US
Practice Address - Phone:913-827-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040039111N00000X
KS01-05092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N12960Medicare PIN