Provider Demographics
NPI:1245592153
Name:MENGES SMITH, MELISSA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:MENGES SMITH
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 1:12511 MEDINAH RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4127
Mailing Address - Country:US
Mailing Address - Phone:719-469-2657
Mailing Address - Fax:
Practice Address - Street 1:7495 MCLAUGHLIN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-4706
Practice Address - Country:US
Practice Address - Phone:719-469-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor