Provider Demographics
NPI:1437545118
Name:GONICK, MEGHAN (ND, LAC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GONICK
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ROMAINE
Other - Last Name:GONICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND, LAC
Mailing Address - Street 1:228 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2962
Mailing Address - Country:US
Mailing Address - Phone:717-869-1524
Mailing Address - Fax:
Practice Address - Street 1:228 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2962
Practice Address - Country:US
Practice Address - Phone:717-869-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000625171100000X
CT000542175F00000X
PAAK001188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath