MEDICARE: MISS MELISSA KATHLEEN PLACE D.C.

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	CHIR008048	GA

General Provider Information

NPI Number	:	1659589778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA KATHLEEN PLACE D.C.

Provider Business Mailing Address
First Line	:	196 MEADOR WAY SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-6621
Country	:	US
Telephone Number	:	678-793-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3911
Country	:	US
Telephone Number	:	404-248-1771
Fax Number	:	404-248-1764

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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