Individual
DUSTIN MELVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
7300 E 56TH ST, INDIANAPOLIS, IN 46226-1306
(317) 964-7445
Mailing address
7300 E 56TH ST, INDIANAPOLIS, IN 46226-1306
(317) 964-7445
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002015A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000003499
BOC
IN
Enumeration date
11/16/2016
Last updated
11/16/2016
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