Provider Demographics
NPI:1639686892
Name:DEWALT, MELISSA REGINA (DC, MS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:REGINA
Last Name:DEWALT
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:REGINA
Other - Last Name:ROWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:100 SPRINGHEAD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9045
Mailing Address - Country:US
Mailing Address - Phone:717-442-1919
Mailing Address - Fax:
Practice Address - Street 1:100 SPRINGHEAD RD STE 1
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9045
Practice Address - Country:US
Practice Address - Phone:717-442-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor