Provider Demographics
NPI:1356430110
Name:MCNICHOLAS, MEGHAN M (DC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:M
Last Name:MCNICHOLAS
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 1:31 LIBERTY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3114
Mailing Address - Country:US
Mailing Address - Phone:860-276-9970
Mailing Address - Fax:860-276-9717
Practice Address - Street 1:31 LIBERTY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3114
Practice Address - Country:US
Practice Address - Phone:860-276-9970
Practice Address - Fax:860-276-9717
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88415Medicare UPIN
CT350001165Medicare ID - Type Unspecified