Provider Demographics
NPI:1548590896
Name:ELLWANGER, MEGAN ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ANN
Last Name:ELLWANGER
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 1:3311 COUNTY RD 101
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-405-6853
Mailing Address - Fax:
Practice Address - Street 1:3311 COUNTY RD 101
Practice Address - Street 2:SUITE 2
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-405-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1548590896OtherBCBS