Provider Demographics
NPI:1801013644
Name:MELBY CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:MELBY CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:MELBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-878-4109
Mailing Address - Street 1:1208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1304
Mailing Address - Country:US
Mailing Address - Phone:262-878-4109
Mailing Address - Fax:262-878-3132
Practice Address - Street 1:1208 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1304
Practice Address - Country:US
Practice Address - Phone:262-878-4109
Practice Address - Fax:262-878-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2071-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty