Provider Demographics
NPI:1821566902
Name:MANILLA, MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MANILLA
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 1:1250 W 75TH ST APT 406
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2992
Mailing Address - Country:US
Mailing Address - Phone:440-478-9040
Mailing Address - Fax:
Practice Address - Street 1:15644 MADISON AVE STE 213
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:216-801-4322
Practice Address - Fax:216-765-9641
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0390137Medicaid