Provider Demographics
NPI:1346508181
Name:BLOCK, MELISSA SNYDER (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SNYDER
Last Name:BLOCK
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 1ST AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4517
Mailing Address - Country:US
Mailing Address - Phone:406-209-9706
Mailing Address - Fax:
Practice Address - Street 1:2313 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2109
Practice Address - Country:US
Practice Address - Phone:424-442-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14649171100000X
MT88186171100000X
CAAC14649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty