Provider Demographics
NPI:1902962269
Name:KRAAYVANGER, MELISA A (DC)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:A
Last Name:KRAAYVANGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:A
Other - Last Name:GOAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:827 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3307
Mailing Address - Country:US
Mailing Address - Phone:360-757-4101
Mailing Address - Fax:360-757-4808
Practice Address - Street 1:827 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3307
Practice Address - Country:US
Practice Address - Phone:360-757-4101
Practice Address - Fax:360-757-4808
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA139434OtherWC L&I
U80368Medicare UPIN
WA139434OtherWC L&I