Provider Demographics
NPI:1912904368
Name:KISLA, MELISSA E (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:E
Last Name:KISLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:990 BEN FRANKLIN HWY E
Mailing Address - Street 2:STE 204
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9547
Mailing Address - Country:US
Mailing Address - Phone:610-385-1444
Mailing Address - Fax:610-385-1441
Practice Address - Street 1:1976 E HIGH ST
Practice Address - Street 2:STE 204
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3277
Practice Address - Country:US
Practice Address - Phone:610-327-8090
Practice Address - Fax:610-327-0970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007901-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU82410Medicare UPIN
PA043260PLUMedicare ID - Type Unspecified
PA044684Medicare ID - Type UnspecifiedGROUP ID NUMBER