Provider Demographics
NPI:1922324094
Name:PONCE, MELISSA P (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:P
Last Name:PONCE
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 1:5718 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2112
Mailing Address - Country:US
Mailing Address - Phone:415-379-9830
Mailing Address - Fax:415-379-9807
Practice Address - Street 1:5718 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2112
Practice Address - Country:US
Practice Address - Phone:415-379-9830
Practice Address - Fax:415-379-9807
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31510111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition