Provider Demographics
NPI:1720071400
Name:FEIWELL, MELISSA JASON (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JASON
Last Name:FEIWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:JASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1066 4TH STREET SUITE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-545-1650
Mailing Address - Fax:707-545-1161
Practice Address - Street 1:1066 4TH STREET SUITE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-545-1650
Practice Address - Fax:707-545-1161
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95015Medicare UPIN