Provider Demographics
NPI:1750578563
Name:LOIDOLT, MELISSA M (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:LOIDOLT
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 32ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1649
Mailing Address - Country:US
Mailing Address - Phone:320-230-8920
Mailing Address - Fax:320-230-8922
Practice Address - Street 1:1246 32ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1649
Practice Address - Country:US
Practice Address - Phone:320-230-8920
Practice Address - Fax:320-230-8922
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003361Medicare PIN
U97887Medicare UPIN