Provider Demographics
NPI:1912214982
Name:BRENT, MEAGHAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:S
Last Name:BRENT
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 1:6531 WHEATON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7253
Mailing Address - Country:US
Mailing Address - Phone:517-812-5629
Mailing Address - Fax:
Practice Address - Street 1:1216 WILDWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4251
Practice Address - Country:US
Practice Address - Phone:517-315-4468
Practice Address - Fax:517-315-4478
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor