Provider Demographics
NPI:1306178884
Name:DIAZ, MELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DIAZ
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 1:160 SPEEN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-2003
Mailing Address - Country:US
Mailing Address - Phone:508-309-7445
Mailing Address - Fax:508-309-7446
Practice Address - Street 1:160 SPEEN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-2003
Practice Address - Country:US
Practice Address - Phone:508-309-7445
Practice Address - Fax:508-309-7446
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA03267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015077Medicare PIN