Provider Demographics
NPI:1619028792
Name:BANYAI, MELISSA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROSE
Last Name:BANYAI
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 1:32 LAKEFIELD PLACE CT APT A
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1673
Mailing Address - Country:US
Mailing Address - Phone:636-675-8196
Mailing Address - Fax:
Practice Address - Street 1:281 CLARKSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2281
Practice Address - Country:US
Practice Address - Phone:636-207-9500
Practice Address - Fax:636-207-9555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor