Provider Demographics
NPI:1083910327
Name:RAIGAN, MELISSA ANN (DC, LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:RAIGAN
Suffix:
Gender:F
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SAINT ANN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3219
Mailing Address - Country:US
Mailing Address - Phone:985-624-9888
Mailing Address - Fax:
Practice Address - Street 1:221 SAINT ANN DR STE 2
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3219
Practice Address - Country:US
Practice Address - Phone:985-624-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor