Provider Demographics
NPI:1043235146
Name:DRISKO, MELVILLE A III (LAC)
Entity Type:Individual
Prefix:
First Name:MELVILLE
Middle Name:A
Last Name:DRISKO
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6018
Mailing Address - Country:US
Mailing Address - Phone:303-399-4373
Mailing Address - Fax:
Practice Address - Street 1:234 NEWPORT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6018
Practice Address - Country:US
Practice Address - Phone:303-399-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO596171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist