Provider Demographics
NPI:1710355334
Name:ROBERTS, MELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ROBERTS
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 1:226 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2918
Mailing Address - Country:US
Mailing Address - Phone:203-586-1466
Mailing Address - Fax:203-586-1477
Practice Address - Street 1:226 MAIN ST N
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-2918
Practice Address - Country:US
Practice Address - Phone:860-838-1038
Practice Address - Fax:203-586-1477
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor