=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710755897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE NUTHALS DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2023
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42040 CYPRESS PARKWAY SUITE 2
-----------------------------------------------------
City | BABCOCK RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-297-5235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15895 TALON TER
-----------------------------------------------------
City | BABCOCK RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33982-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-297-5235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6148-12
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 15140
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------