MEDICARE: MELANIE C MASSARE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10443	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8S7577	OTHER	TX	BLUECROSS BLUESHIELD
2	12522367	OTHER		CAQH
3	9943460	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1609083112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE C MASSARE D.C.

Provider Business Mailing Address
First Line	:	6825 STEWART RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1841
Country	:	US
Telephone Number	:	409-744-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 STEWART RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1841
Country	:	US
Telephone Number	:	409-744-2225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/06/2014

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