Healthcare Provider Details

I. General information

NPI: 1629580972
Provider Name (Legal Business Name): MELISSA MCKINNEY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 SOLIMAR WAY
MARY ESTHER FL
32569-1421
US

IV. Provider business mailing address

863 SOLIMAR WAY
MARY ESTHER FL
32569-1421
US

V. Phone/Fax

Practice location:
  • Phone: 850-797-8144
  • Fax:
Mailing address:
  • Phone: 850-797-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH11812
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH11812
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH11812
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: