Provider Demographics
NPI:1578573473
Name:SANNELLI, MELISSA MAKIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MAKIN
Last Name:SANNELLI
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:PO BOX 8563
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8563
Mailing Address - Country:US
Mailing Address - Phone:732-530-7229
Mailing Address - Fax:732-530-4665
Practice Address - Street 1:252 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2012
Practice Address - Country:US
Practice Address - Phone:732-530-7229
Practice Address - Fax:732-530-4665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ879208Medicare ID - Type Unspecified