Provider Demographics
NPI:1003079245
Name:MELISSA ENGELSON, DC, PLLC
Entity Type:Organization
Organization Name:MELISSA ENGELSON, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-567-1005
Mailing Address - Street 1:15815 FRANKLIN TRL SE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15815 FRANKLIN TRL SE
Practice Address - Street 2:SUITE 500
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2076
Practice Address - Country:US
Practice Address - Phone:952-567-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty