Provider Demographics
NPI:1962868489
Name:CHESLEY, MELODY (LAC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:CHESLEY
Suffix:
Gender:F
Credentials:LAC
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 2152
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2152
Mailing Address - Country:US
Mailing Address - Phone:907-299-6406
Mailing Address - Fax:
Practice Address - Street 1:4164 PENNOCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7239
Practice Address - Country:US
Practice Address - Phone:907-299-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist