Provider Demographics
NPI:1497784011
Name:BLOUNT, MEGAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:BLOUNT
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 1:210 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1163
Mailing Address - Country:US
Mailing Address - Phone:608-846-2454
Mailing Address - Fax:608-846-2404
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1163
Practice Address - Country:US
Practice Address - Phone:608-846-2454
Practice Address - Fax:608-846-2404
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3744-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38931900Medicaid
WIU85009Medicare UPIN