MEDICARE: MELISSA LE NICOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1114543147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LE NICOL

Provider Business Mailing Address
First Line	:	6350 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N RAVENSWOOD AVE STE 105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	773-878-7330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	06/25/2020

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Directions to “ MELISSA LE NICOL ” Practice Location

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