Healthcare Provider Details

I. General information

NPI: 1659334340
Provider Name (Legal Business Name): MELVIN J KUKICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ROBBINS STATION RD
NORTH HUNTINGDON PA
15642-2204
US

IV. Provider business mailing address

212 ROBBINS STATION RD
NORTH HUNTINGDON PA
15642-2204
US

V. Phone/Fax

Practice location:
  • Phone: 724-861-0280
  • Fax: 724-861-0281
Mailing address:
  • Phone: 724-861-0280
  • Fax: 724-861-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-003954L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: