Healthcare Provider Details

I. General information

NPI: 1629119763
Provider Name (Legal Business Name): MELISSA ANN EDWARDS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
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: 859-814-1400
  • Fax: 859-485-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: