Provider Demographics
NPI:1548265853
Name:MELMAN, JONATHAN MARK (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:MELMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 BOYLSTON ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4809
Mailing Address - Country:US
Mailing Address - Phone:617-421-1881
Mailing Address - Fax:617-236-0359
Practice Address - Street 1:667 BOYLSTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4809
Practice Address - Country:US
Practice Address - Phone:617-421-1881
Practice Address - Fax:617-236-0359
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 1248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0604520OtherAETNA/US HEALTHCARE
MA726727OtherTUFTS
MA2906313-001OtherCIGNA
MAAA3766OtherHARVARD PILGRIM HEALTH CA
MAY35915OtherBLUE CROSS BLUE SHIELD
MA726727OtherTUFTS
MAY35915Medicare ID - Type UnspecifiedMEDICARE
MA0604520OtherAETNA/US HEALTHCARE
MATX0786Medicare PIN