Provider Demographics
NPI:1306815303
Name:FAULKENBERRY, MELISSA JANE (DC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:FAULKENBERRY
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 1:11125 ARCADE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4088
Mailing Address - Country:US
Mailing Address - Phone:501-225-1371
Mailing Address - Fax:501-225-1033
Practice Address - Street 1:11125 ARCADE DR
Practice Address - Street 2:STE D
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4088
Practice Address - Country:US
Practice Address - Phone:501-225-1371
Practice Address - Fax:501-225-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136308718Medicaid
AR136308718Medicaid