Provider Demographics
NPI:1114256088
Name:TANK, MEGGAN M (DC)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:M
Last Name:TANK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MEGGAN
Other - Middle Name:M
Other - Last Name:CAPTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2630
Mailing Address - Country:US
Mailing Address - Phone:608-372-2747
Mailing Address - Fax:608-372-3100
Practice Address - Street 1:1100 KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2630
Practice Address - Country:US
Practice Address - Phone:608-372-2747
Practice Address - Fax:608-372-3100
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4560-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor