Provider Demographics
NPI:1740381805
Name:SWANSON, MELANIE LISA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LISA
Last Name:SWANSON
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:PO BOX 9263
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67277-0263
Mailing Address - Country:US
Mailing Address - Phone:316-283-3822
Mailing Address - Fax:316-283-3751
Practice Address - Street 1:8000 W CENTRAL AVE
Practice Address - Street 2:STE 400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67277-0263
Practice Address - Country:US
Practice Address - Phone:316-283-3822
Practice Address - Fax:316-283-3751
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU51625Medicare UPIN
KS055926Medicare Oscar/Certification
KS055926Medicare PIN
KS055926Medicare UPIN