Provider Demographics
NPI:1811378011
Name:FAULKNER, MEGHAN
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10960 E CRYSTAL FALLS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2251
Mailing Address - Country:US
Mailing Address - Phone:770-827-3340
Mailing Address - Fax:
Practice Address - Street 1:2303 S BAGDAD RD STE 200
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-2432
Practice Address - Country:US
Practice Address - Phone:512-528-6009
Practice Address - Fax:512-528-3690
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12965111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V012ZQD4Medicare UPIN