Provider Demographics
NPI:1629119763
Name:EDWARDS, MELISSA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:EDWARDS
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 1:93 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:859-814-1400
Mailing Address - Fax:859-485-9545
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000107002Medicaid
KY85000107002Medicaid
KY1821601Medicare ID - Type Unspecified