Provider Demographics
NPI:1619986908
Name:LOGUE, MELISSA L (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:LOGUE
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 1:2508 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1726
Mailing Address - Country:US
Mailing Address - Phone:970-530-0420
Mailing Address - Fax:970-223-2439
Practice Address - Street 1:2508 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1726
Practice Address - Country:US
Practice Address - Phone:970-530-0420
Practice Address - Fax:970-223-2439
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC040759Medicare PIN
COV05905Medicare UPIN