Provider Demographics
NPI:1952073942
Name:CHACON-LOPEZ, MELISSA (BA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CHACON-LOPEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4603
Mailing Address - Country:US
Mailing Address - Phone:503-434-7462
Mailing Address - Fax:
Practice Address - Street 1:169 WHITMAN ST N
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1323
Practice Address - Country:US
Practice Address - Phone:971-901-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist