Healthcare Provider Details

I. General information

NPI: 1649670514
Provider Name (Legal Business Name): MELISSA ODETTE GUERRA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 S GREAT SOUTHWEST PKWY STE 505
GRAND PRAIRIE TX
75051-3546
US

IV. Provider business mailing address

118 W VILLAGE BLVD
LAREDO TX
78041-2259
US

V. Phone/Fax

Practice location:
  • Phone: 972-647-2400
  • Fax: 972-623-3400
Mailing address:
  • Phone: 956-725-5630
  • Fax: 956-725-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: