Provider Demographics
NPI:1417002270
Name:HANEY, MELISSA GENELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GENELLE
Last Name:HANEY
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 1:793 WHITLOCK AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3001
Mailing Address - Country:US
Mailing Address - Phone:770-419-9244
Mailing Address - Fax:
Practice Address - Street 1:793 WHITLOCK AVE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3001
Practice Address - Country:US
Practice Address - Phone:770-419-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV08586Medicare UPIN
GA35ZCJNJMedicare ID - Type Unspecified