Healthcare Provider Details

I. General information

NPI: 1598823908
Provider Name (Legal Business Name): MELANIE P. MULLENMEISTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WEST HAVENS STREET SUITE 3
MITCHELL SD
57301-4116
US

IV. Provider business mailing address

1415 WEST HAVENS STREET SUITE 3
MITCHELL SD
57301-4116
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-1160
  • Fax: 605-996-6433
Mailing address:
  • Phone: 605-996-1160
  • Fax: 605-996-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1039
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: