Provider Demographics
NPI:1821291386
Name:WALCOTT, MELANIE YOLANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:YOLANDA
Last Name:WALCOTT
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 1:4031 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2232
Mailing Address - Country:US
Mailing Address - Phone:917-456-7671
Mailing Address - Fax:
Practice Address - Street 1:4256 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2611
Practice Address - Country:US
Practice Address - Phone:718-655-0130
Practice Address - Fax:718-655-0133
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011377-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor