MEDICARE: MELODY D HEYDINGER, DC, PROF CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3126	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V37589	OTHER	NV	MEDICARE GROUP

General Provider Information

NPI Number	:	1205035375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELODY D HEYDINGER, DC, PROF CORP

Provider Business Mailing Address
First Line	:	201 S KIBLER ST
Second Line	:	PO BOX 325
City	:	NEW WASHINGTON
State	:	OH
Zip	:	44854-9771
Country	:	US
Telephone Number	:	419-492-2129
Fax Number	:	419-492-3344

Provider Business Practice Location Address
First Line	:	201 S KIBLER ST
Second Line	:
City	:	NEW WASHINGTON
State	:	OH
Zip	:	44854-9771
Country	:	US
Telephone Number	:	419-492-2129
Fax Number	:	419-492-3344

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. MELODY D. HEYDINGERDC
Credential	:	DC
Telephone Number	:	702-932-6100

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/11/2014

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