Provider Demographics
NPI:1699899245
Name:DIAS, MELANIE (DC)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:DIAS
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:PO BOX 10774
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0774
Mailing Address - Country:US
Mailing Address - Phone:602-677-8162
Mailing Address - Fax:623-566-4918
Practice Address - Street 1:17235 N 75TH AVE
Practice Address - Street 2:SUITE F110
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0831
Practice Address - Country:US
Practice Address - Phone:623-572-4476
Practice Address - Fax:623-566-4918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU88257Medicare UPIN
AZZ109096Medicare ID - Type Unspecified