Provider Demographics
NPI:1164413373
Name:KUCERA, MELISSA LYNN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:KUCERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253
Mailing Address - Country:US
Mailing Address - Phone:336-229-4345
Mailing Address - Fax:336-229-6118
Practice Address - Street 1:845 SOUTH MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-229-4345
Practice Address - Fax:336-229-6118
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor