Provider Demographics
NPI:1083822902
Name:WILCOX, MELISSA DORA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DORA
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 HWY 53 EAST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-265-7339
Mailing Address - Fax:706-216-1209
Practice Address - Street 1:6564 HIGHWAY 53 E
Practice Address - Street 2:SUITE 100
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6806
Practice Address - Country:US
Practice Address - Phone:706-265-7339
Practice Address - Fax:706-216-1209
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU83384Medicare UPIN
OH4040181Medicare ID - Type Unspecified