Provider Demographics
NPI:1154801355
Name:DEHART, MELISSA GRACE (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GRACE
Last Name:DEHART
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 1:2756 VEACH RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6219
Mailing Address - Country:US
Mailing Address - Phone:270-688-0234
Mailing Address - Fax:270-688-0487
Practice Address - Street 1:2756 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6219
Practice Address - Country:US
Practice Address - Phone:270-314-0149
Practice Address - Fax:270-688-0487
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor