Provider Demographics
NPI:1720196157
Name:MELILLO, DENNIS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:MELILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ROUTE 519
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823
Mailing Address - Country:US
Mailing Address - Phone:908-475-2007
Mailing Address - Fax:908-473-2001
Practice Address - Street 1:540 ROUTE 519
Practice Address - Street 2:SUITE 3
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823
Practice Address - Country:US
Practice Address - Phone:908-475-2007
Practice Address - Fax:908-473-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC001981111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
453420Medicare ID - Type Unspecified