Provider Demographics
NPI:1851685408
Name:BRUXVOORT, MELINDA KAY (DC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:KAY
Last Name:BRUXVOORT
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 1:3409 BURTON RIDGE RD SE
Mailing Address - Street 2:APT E
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5824
Mailing Address - Country:US
Mailing Address - Phone:319-621-8544
Mailing Address - Fax:
Practice Address - Street 1:111 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-9167
Practice Address - Country:US
Practice Address - Phone:269-205-2300
Practice Address - Fax:269-205-2301
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007372111N00000X
MI2301009760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor