Provider Demographics
NPI:1154093565
Name:MCGWIN, MELISSA ASHLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ASHLEY
Last Name:MCGWIN
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 1:42 BROADWAY STE 1535
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-3885
Mailing Address - Country:US
Mailing Address - Phone:212-393-4673
Mailing Address - Fax:
Practice Address - Street 1:42 BROADWAY STE 1535
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3885
Practice Address - Country:US
Practice Address - Phone:212-393-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor