Provider Demographics
NPI:1902083363
Name:MELANSON, DANIELLE JEAN (LAC DIP OM)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:MELANSON
Suffix:
Gender:F
Credentials:LAC DIP OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2230
Mailing Address - Country:US
Mailing Address - Phone:503-701-1854
Mailing Address - Fax:
Practice Address - Street 1:208 STATE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:503-701-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR99984OtherNCCAOM CERTIFICATION
ORAC01169OtherOREGON BME, LICENSE