Healthcare Provider Details

I. General information

NPI: 1619183621
Provider Name (Legal Business Name): MELISSA G. OLMSTED D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 LAKE MARIAM BLVD
WINTER HAVEN FL
33884-3815
US

IV. Provider business mailing address

327 LAKE MARIAM BLVD
WINTER HAVEN FL
33884-3815
US

V. Phone/Fax

Practice location:
  • Phone: 863-585-4440
  • Fax:
Mailing address:
  • Phone: 863-585-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: