Provider Demographics
NPI:1376592535
Name:LITTLETON, MELANEY YAJUAN (DC)
Entity type:Individual
Prefix:DR
First Name:MELANEY
Middle Name:YAJUAN
Last Name:LITTLETON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELANEY
Other - Middle Name:YAJUAN
Other - Last Name:LITTLETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8420 DELMAR BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2170
Mailing Address - Country:US
Mailing Address - Phone:314-997-4460
Mailing Address - Fax:314-997-2306
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:314-997-4460
Practice Address - Fax:314-997-2306
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2004021551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO74-3168329OtherTAX ID
MOMA1866OtherMEDICARE PROVIDER NUMBER
MOM0459OtherMEDICARE SUBMITTER ID