Provider Demographics
NPI:1164287397
Name:CANCHOLA, MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CANCHOLA
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 1:15367 S DARNELL ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3355
Mailing Address - Country:US
Mailing Address - Phone:913-215-3793
Mailing Address - Fax:
Practice Address - Street 1:14864 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2206
Practice Address - Country:US
Practice Address - Phone:913-656-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor