Provider Demographics
NPI:1174617930
Name:BAUCH-MURPHY, MELISSA LEMAIRE (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LEMAIRE
Last Name:BAUCH-MURPHY
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 1:114 ACKERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4202
Mailing Address - Country:US
Mailing Address - Phone:201-447-5615
Mailing Address - Fax:201-652-9570
Practice Address - Street 1:385 S MAPLE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1543
Practice Address - Country:US
Practice Address - Phone:201-652-9590
Practice Address - Fax:201-652-9570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00509300111N00000X
GACHIRO005814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ005922Medicare PIN