Provider Demographics
NPI:1588202857
Name:PODOLSKY, MEGHAN NICHOLS (DACM, DIPL OM, LAC)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:NICHOLS
Last Name:PODOLSKY
Suffix:
Gender:F
Credentials:DACM, DIPL OM, LAC
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:ANNE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:2310 FLORIDA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3538
Mailing Address - Country:US
Mailing Address - Phone:260-241-1505
Mailing Address - Fax:
Practice Address - Street 1:1136 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4312
Practice Address - Country:US
Practice Address - Phone:260-222-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18730171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18730OtherCALIFORNIA ACUPUNCTURE BOARD
172423OtherNATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE AND ORIENTAL MEDICINE (NCCAOM)
IN84000243AOtherINDIANA PROFESSIONAL LICENSING AGENCY