Provider Demographics
NPI:1124058573
Name:KINCAID, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RAILROAD ST
Mailing Address - Street 2:STE 100A
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1948
Mailing Address - Country:US
Mailing Address - Phone:608-524-1198
Mailing Address - Fax:608-524-1187
Practice Address - Street 1:146 RAILROAD ST STE 100A
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1948
Practice Address - Country:US
Practice Address - Phone:608-524-1198
Practice Address - Fax:608-524-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3433-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38908400Medicaid
WI38908400Medicaid