Provider Demographics
NPI:1609083112
Name:MASSARE, MELANIE C (DC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:MASSARE
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 1:6825 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1841
Mailing Address - Country:US
Mailing Address - Phone:409-744-2225
Mailing Address - Fax:
Practice Address - Street 1:6825 STEWART RD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1841
Practice Address - Country:US
Practice Address - Phone:409-744-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7577OtherBLUECROSS BLUESHIELD
12522367OtherCAQH
TX9943460OtherAETNA
TX1063768OtherBLUELINK