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General NPI Number Information
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NPI Number | 1851685408
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Entity Type | Individual
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Provider Name | MELINDA KAY BRUXVOORT DC
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 111 S BROADWAY ST
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City | MIDDLEVILLE
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State | MI
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Zip | 49333-9167
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Country | US
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Telephone | 269-205-2300
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Fax | 269-205-2301
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Provider Business Mailing Address
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Address Line | 3409 BURTON RIDGE RD SE APT E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5824
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Country | US
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Telephone | 319-621-8544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 007372
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009760
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License Number State | MI
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