Provider Demographics
NPI:1568661858
Name:MISSAKIAN, MASSEY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MASSEY
Middle Name:WAYNE
Last Name:MISSAKIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MISSAKIAN
Other - Middle Name:
Other - Last Name:INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3711
Mailing Address - Country:US
Mailing Address - Phone:559-781-3033
Mailing Address - Fax:559-781-3073
Practice Address - Street 1:83 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3711
Practice Address - Country:US
Practice Address - Phone:559-781-3033
Practice Address - Fax:559-781-3073
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor