Provider Demographics
NPI:1881845840
Name:ELLIS, MELISSA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:ELLIS
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 1:3 PARKMONT TRCE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1708
Mailing Address - Country:US
Mailing Address - Phone:678-491-0610
Mailing Address - Fax:
Practice Address - Street 1:1655 MANSELL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4850
Practice Address - Country:US
Practice Address - Phone:770-992-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor