Provider Demographics
NPI:1295855427
Name:ROBERTS, MELISSA (L AC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:351 MORAINE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8055
Mailing Address - Country:US
Mailing Address - Phone:970-577-9725
Mailing Address - Fax:
Practice Address - Street 1:351 MORAINE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8055
Practice Address - Country:US
Practice Address - Phone:970-577-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO746171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist