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General NPI Number Information
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NPI Number | 1124317524
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Entity Type | Individual
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Provider Name | KIMBERLY MELANCON
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 2424 WILLIAMS BLVD SUITE A AND B
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City | KENNER
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State | LA
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Zip | 70062-5763
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Country | US
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Telephone | 504-464-0719
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Fax | 504-464-0721
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Provider Business Mailing Address
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Address Line | 2424 WILLIAMS BLVD SUITE A AND B
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City | KENNER
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State | LA
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Zip | 70062-5763
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1591
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License Number State | LA
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