Provider Demographics
NPI:1003002486
Name:MINNER, MEGAN KATHLEEN (DC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:MINNER
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 1:1115 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3303
Mailing Address - Country:US
Mailing Address - Phone:636-239-9997
Mailing Address - Fax:636-239-9931
Practice Address - Street 1:1115 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3303
Practice Address - Country:US
Practice Address - Phone:636-239-9997
Practice Address - Fax:636-239-9931
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1100652OtherCIGNA PIN
MO261152778MINOtherMERCY PIN
MO714177OtherUNITED HEALTHCARE PIN
MO9058107OtherAETNA PIN
MO261445480Medicare PIN