Healthcare Provider Details

I. General information

NPI: 1982932257
Provider Name (Legal Business Name): MELISSA ANN KACI KOLENDA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN KACI MEDEIROS

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 BUSCH LAKE BLVD
TAMPA FL
33614-1860
US

IV. Provider business mailing address

2901 BUSCH LAKE BLVD
TAMPA FL
33614-1860
US

V. Phone/Fax

Practice location:
  • Phone: 813-936-7979
  • Fax: 813-936-1600
Mailing address:
  • Phone: 813-936-7979
  • Fax: 813-936-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: