Healthcare Provider Details

I. General information

NPI: 1558350843
Provider Name (Legal Business Name): HEART OF HEALING CHIROPRACTIC CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N MAIN ST
WALTON KY
41094-1130
US

IV. Provider business mailing address

93 N MAIN ST
WALTON KY
41094-1130
US

V. Phone/Fax

Practice location:
  • Phone: 859-485-9545
  • Fax: 859-485-1360
Mailing address:
  • Phone: 859-485-9545
  • Fax: 859-485-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4402
License Number StateKY

VIII. Authorized Official

Name: DR. MELISSA ANN EDWARDS
Title or Position: PRESIDENT/PHYSICIAN
Credential: DC
Phone: 859-485-9545