Provider Demographics
NPI:1609938125
Name:MADER, MELODY SUE (DC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:SUE
Last Name:MADER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LODY
Other - Middle Name:
Other - Last Name:MADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-0560
Mailing Address - Country:US
Mailing Address - Phone:573-346-2335
Mailing Address - Fax:573-346-2334
Practice Address - Street 1:41 CAMDEN COURT SOUTHWEST
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020
Practice Address - Country:US
Practice Address - Phone:573-346-2335
Practice Address - Fax:573-346-2334
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCEOO6535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU65194Medicare UPIN