Provider Demographics
NPI:1356766760
Name:WALL, MEGAN (DC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WALL
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 1:5201 EDEN AVE
Mailing Address - Street 2:STE 190
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2368
Mailing Address - Country:US
Mailing Address - Phone:952-920-9721
Mailing Address - Fax:952-241-4355
Practice Address - Street 1:8439 GROVE PL
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8518
Practice Address - Country:US
Practice Address - Phone:712-251-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor