Provider Demographics
NPI:1023639432
Name:HARRISON, MELISSA (DC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:HARRISON
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 1:1057 NE QUEENS CIR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1771
Mailing Address - Country:US
Mailing Address - Phone:816-695-7176
Mailing Address - Fax:
Practice Address - Street 1:1057 NE QUEENS CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1771
Practice Address - Country:US
Practice Address - Phone:816-695-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019001343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty