Provider Demographics
NPI:1710318464
Name:FOUGHT, MEGHAN BRIE (DC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:BRIE
Last Name:FOUGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:BRIE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7 1/2 MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1906
Mailing Address - Country:US
Mailing Address - Phone:518-932-2137
Mailing Address - Fax:
Practice Address - Street 1:7 1/2 MAYNARD ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1906
Practice Address - Country:US
Practice Address - Phone:518-932-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010474111N00000X
NY012450111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation