Provider Demographics
NPI:1063591121
Name:DENCKLAU, MELISSA A (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:DENCKLAU
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 1:1107 E BELL RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2691
Mailing Address - Country:US
Mailing Address - Phone:602-866-3500
Mailing Address - Fax:602-866-3510
Practice Address - Street 1:1107 E BELL RD
Practice Address - Street 2:SUITE 14
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2691
Practice Address - Country:US
Practice Address - Phone:602-866-3500
Practice Address - Fax:602-866-3510
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor