1861761736 NPI number — DR. MELISSA SUSANNE WASZAK D.C.

Table of content: DR. MELISSA SUSANNE WASZAK D.C. (NPI 1861761736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861761736 NPI number — DR. MELISSA SUSANNE WASZAK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASZAK
Provider First Name:
MELISSA
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WASZAK
Provider Other First Name:
MELISSA
Provider Other Middle Name:
SUSANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861761736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3821 N 167TH CT
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68116-8071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-932-5066
Provider Business Mailing Address Fax Number:
402-932-5067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3821 N 167TH CT
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68116-8070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-932-5066
Provider Business Practice Location Address Fax Number:
402-932-5067
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1697 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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