Provider Demographics
NPI:1689474033
Name:HUBER, MELISSA (DC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HUBER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2739
Mailing Address - Country:US
Mailing Address - Phone:480-694-4107
Mailing Address - Fax:
Practice Address - Street 1:1263 LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2739
Practice Address - Country:US
Practice Address - Phone:480-694-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038014253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor