Provider Demographics
NPI:1972506004
Name:CUSTER, MEGHAN ANN I (DC)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ANN
Last Name:CUSTER
Suffix:I
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 1:4422 IVY COMMONS
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7123
Mailing Address - Country:US
Mailing Address - Phone:434-825-5717
Mailing Address - Fax:
Practice Address - Street 1:4422 IVY COMMONS
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7123
Practice Address - Country:US
Practice Address - Phone:434-817-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA293442OtherMAMSI/ ALLIANCE
VA451931OtherANTHEM
VA700027234OtherCIGNA
VA011082000OtherSOUTHERN HEALTH
VA1914401229OtherMAIL HANDLERS
VA700027234OtherCIGNA
VA451931OtherANTHEM