Provider Demographics
NPI:1881953420
Name:BERRY, MEGHAN RHEA (DC)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:RHEA
Last Name:BERRY
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 1:340 N 179TH CT W
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8494
Mailing Address - Country:US
Mailing Address - Phone:316-992-9361
Mailing Address - Fax:316-831-9233
Practice Address - Street 1:1999 N AMIDON AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2121
Practice Address - Country:US
Practice Address - Phone:316-992-9361
Practice Address - Fax:316-831-9233
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor