Provider Demographics
NPI:1558350843
Name:HEART OF HEALING CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:HEART OF HEALING CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-485-9545
Mailing Address - Street 1:93 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-1130
Mailing Address - Country:US
Mailing Address - Phone:859-485-9545
Mailing Address - Fax:859-485-1360
Practice Address - Street 1:93 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-1130
Practice Address - Country:US
Practice Address - Phone:859-485-9545
Practice Address - Fax:859-485-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85900355Medicaid
U69574Medicare UPIN
KY85900355Medicaid