Provider Demographics
NPI:1578749222
Name:LEVERETTE, MELISSA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:LEVERETTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:BOLLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9766
Mailing Address - Country:US
Mailing Address - Phone:859-263-2774
Mailing Address - Fax:859-263-2787
Practice Address - Street 1:1890 STAR SHOOT PKWY STE 185
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4567
Practice Address - Country:US
Practice Address - Phone:859-263-2774
Practice Address - Fax:859-263-2787
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100240790Medicaid
KYK082582Medicare PIN
KYK082580Medicare PIN