Provider Demographics
NPI:1437582830
Name:CHANHNOUVONG, MEGAN NICOLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:CHANHNOUVONG
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 1:813 OAK ST STE 12
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4400
Mailing Address - Country:US
Mailing Address - Phone:501-513-3322
Mailing Address - Fax:501-513-3065
Practice Address - Street 1:813 OAK ST STE 12
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4400
Practice Address - Country:US
Practice Address - Phone:501-513-3322
Practice Address - Fax:501-513-3065
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor