Provider Demographics
NPI:1821538182
Name:BLANCHARD, MELISSA CAROLINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CAROLINE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:CAROLINE
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:19685 PILOT KNOB RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7238
Mailing Address - Country:US
Mailing Address - Phone:651-478-6988
Mailing Address - Fax:651-478-6900
Practice Address - Street 1:19685 PILOT KNOB RD
Practice Address - Street 2:SUITE 260
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7238
Practice Address - Country:US
Practice Address - Phone:651-478-6988
Practice Address - Fax:651-478-6900
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor