Provider Demographics
NPI:1881051357
Name:MCMICHAEL, MEREDYTH RAE (DC, MSACN)
Entity type:Individual
Prefix:DR
First Name:MEREDYTH
Middle Name:RAE
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:DC, MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-8910
Mailing Address - Country:US
Mailing Address - Phone:315-694-2075
Mailing Address - Fax:
Practice Address - Street 1:640 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1035
Practice Address - Country:US
Practice Address - Phone:315-694-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70-012824111N00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program