Provider Demographics
NPI:1346487113
Name:MEEHAN, CHRISTIE L (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:L
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17345 ENADIA WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3542
Mailing Address - Country:US
Mailing Address - Phone:818-216-1374
Mailing Address - Fax:
Practice Address - Street 1:17345 ENADIA WAY
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-3542
Practice Address - Country:US
Practice Address - Phone:818-216-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12639171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist