Provider Demographics
NPI:1932103207
Name:TOBIN, MELISSA ANN (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TOBIN
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 1:82 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1742
Mailing Address - Country:US
Mailing Address - Phone:508-752-7521
Mailing Address - Fax:508-798-3418
Practice Address - Street 1:82 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1742
Practice Address - Country:US
Practice Address - Phone:508-752-7521
Practice Address - Fax:508-798-3418
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45116Medicare ID - Type Unspecified