Provider Demographics
NPI:1689182206
Name:SHORT, MELANIE ELENORA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ELENORA
Last Name:SHORT
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 1:1300 HULL ST S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3224
Mailing Address - Country:US
Mailing Address - Phone:630-399-1308
Mailing Address - Fax:
Practice Address - Street 1:5144 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1833
Practice Address - Country:US
Practice Address - Phone:727-328-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor