Provider Demographics
NPI:1356413942
Name:SENIOR, MELISSA LYN (DC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYN
Last Name:SENIOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYN
Other - Last Name:SENIOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1315 W GRAND PARKWAY S
Mailing Address - Street 2:#103
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-392-8757
Mailing Address - Fax:281-392-8966
Practice Address - Street 1:1315 W GRAND PARKWAY S
Practice Address - Street 2:SUITE 103
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-392-8757
Practice Address - Fax:281-392-8966
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606108OtherBCBS
TX609467Medicare ID - Type Unspecified
U78688Medicare UPIN