MEDICARE: MS. MEGHAN MCKECHNIE LAC

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	171100000X	Acupuncturist	ACU.0002247	CO

General Provider Information

NPI Number	:	1902404056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEGHAN MCKECHNIE LAC

Provider Business Mailing Address
First Line	:	630 8TH ST
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 LAKE AVE
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-9380
Country	:	US
Telephone Number	:	970-532-2755
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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