Provider Demographics
NPI:1114360658
Name:BICHANICH, MELISSA S (LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:BICHANICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E WISCONSIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3034
Mailing Address - Country:US
Mailing Address - Phone:262-995-8778
Mailing Address - Fax:
Practice Address - Street 1:361 YOSEMITE RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2292
Practice Address - Country:US
Practice Address - Phone:262-995-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI788-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist