Healthcare Provider Details

I. General information

NPI: 1437582830
Provider Name (Legal Business Name): MEGAN NICOLE CHANHNOUVONG DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 OAK ST STE 12
CONWAY AR
72032-4400
US

IV. Provider business mailing address

813 OAK ST STE 12
CONWAY AR
72032-4400
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-3322
  • Fax: 501-513-3065
Mailing address:
  • Phone: 501-513-3322
  • Fax: 501-513-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16034
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: