Individual
THERESA MELLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
820 E PARADISE DR, WEST BEND, WI 53095-5383
(262) 334-8188
(262) 334-8166
Mailing address
820 E PARADISE DR, WEST BEND, WI 53095-5383
(262) 334-8188
(262) 334-8166
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5290-12
WI
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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