Provider Demographics
NPI:1033655261
Name:BAKAYSA, MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BAKAYSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2413
Mailing Address - Country:US
Mailing Address - Phone:636-795-1500
Mailing Address - Fax:
Practice Address - Street 1:1016 BURKE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2413
Practice Address - Country:US
Practice Address - Phone:336-281-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor