Provider Demographics
NPI:1790847622
Name:MEEKER-PREGON, MARY ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:MEEKER-PREGON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:MEEKER-PREGON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:112 GRANDE PAS
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3115
Mailing Address - Country:US
Mailing Address - Phone:816-237-1093
Mailing Address - Fax:816-237-1297
Practice Address - Street 1:8014 STATE LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3712
Practice Address - Country:US
Practice Address - Phone:913-642-4188
Practice Address - Fax:913-642-4188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104005111N00000X
MO005797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0002548Medicare ID - Type UnspecifiedPROVIDER NUMBER, LEGACY
KS17960Medicare UPIN