Provider Demographics
NPI:1144570193
Name:EATON, MELISSA DONNA (DOM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DONNA
Last Name:EATON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2141
Mailing Address - Country:US
Mailing Address - Phone:303-656-0048
Mailing Address - Fax:
Practice Address - Street 1:925 37TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2141
Practice Address - Country:US
Practice Address - Phone:303-656-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist