Provider Demographics
NPI:1861761736
Name:WASZAK, MELISSA SUSANNE (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUSANNE
Last Name:WASZAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:SUSANNE
Other - Last Name:WASZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3821 N 167TH CT
Mailing Address - Street 2:STE 110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8071
Mailing Address - Country:US
Mailing Address - Phone:402-932-5066
Mailing Address - Fax:402-932-5067
Practice Address - Street 1:3821 N 167TH CT
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8070
Practice Address - Country:US
Practice Address - Phone:402-932-5066
Practice Address - Fax:402-932-5067
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor