Provider Demographics
NPI:1124491758
Name:BERRY SWADELL, MEGAN (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BERRY SWADELL
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2138
Mailing Address - Country:US
Mailing Address - Phone:650-229-3024
Mailing Address - Fax:
Practice Address - Street 1:1512 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2138
Practice Address - Country:US
Practice Address - Phone:650-229-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist