MEDICARE: DR. MEGAN DEJANA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	713632	OR
2	111N00000X	Chiropractor	CH00034630	WA

General Provider Information

NPI Number	:	1871506600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN DEJANA D.C.

Provider Business Mailing Address
First Line	:	1815 SW MARLOW AVE
Second Line	:	SUITE 206
City	:	PORTLAND
State	:	OR
Zip	:	97225-5185
Country	:	US
Telephone Number	:	503-789-1014
Fax Number	:	877-985-9111

Provider Business Practice Location Address
First Line	:	1815 SW MARLOW AVE
Second Line	:	SUITE 206
City	:	PORTLAND
State	:	OR
Zip	:	97225-5185
Country	:	US
Telephone Number	:	503-789-1014
Fax Number	:	877-985-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/19/2014

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