Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH11812 | FL |
N | 111NN1001X | Nutrition | CH11812 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | CH11812 | FL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH11812 | FL |
NPI | 1629580972 |
---|---|
Provider Name | Melissa Mckinney |
First Address | Mary Esther, FL 32569-1421 |
Second Address | Mary Esther, FL 32569-1421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 26/10/2017 |