Provider Demographics
NPI:1639299191
Name:VAN LOON, MEGHAN (DC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:VAN LOON
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 1:103 SHARLENE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6315
Mailing Address - Country:US
Mailing Address - Phone:607-277-1468
Mailing Address - Fax:607-277-1468
Practice Address - Street 1:103 SHARLENE RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6315
Practice Address - Country:US
Practice Address - Phone:607-277-1468
Practice Address - Fax:607-277-1468
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006651111N00000X
NY8965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000916363001OtherHEALTH NEW - CHIRO
NY000915152001OtherHEALTH NEW - P.T.
NY55597BMedicare ID - Type UnspecifiedMEDICARE
NYU17573Medicare UPIN