MEDICARE: MELISSA LYNN KUCERA

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	111N00000X	Chiropractor	2215	NC

General Provider Information

NPI Number	:	1164413373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN KUCERA

Provider Business Mailing Address
First Line	:	845 SOUTH MAIN ST
Second Line	:	SUITE 100
City	:	GRAHAM
State	:	NC
Zip	:	27253
Country	:	US
Telephone Number	:	336-229-4345
Fax Number	:	336-229-6118

Provider Business Practice Location Address
First Line	:	845 SOUTH MAIN ST
Second Line	:	SUITE 100
City	:	GRAHAM
State	:	NC
Zip	:	27253
Country	:	US
Telephone Number	:	336-229-4345
Fax Number	:	336-229-6118

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/26/2016

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