Provider Demographics
NPI:1013922483
Name:MELESKI, MARK G (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:MELESKI
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 1:211 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1109
Mailing Address - Country:US
Mailing Address - Phone:217-285-4122
Mailing Address - Fax:217-285-5157
Practice Address - Street 1:211 W PERRY ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1109
Practice Address - Country:US
Practice Address - Phone:217-285-4122
Practice Address - Fax:217-285-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL230792OtherHEALTHLINK
IL07521142OtherBCBS OF ILLINOIS
IL230792OtherHEALTHLINK
ILU61349Medicare UPIN