Healthcare Provider Details

I. General information

NPI: 1336920941
Provider Name (Legal Business Name): MEGAN ELIZABETH JEPSEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN ELIZABETH BREMERMAN

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 14TH ST W
BRADENTON FL
34207
US

IV. Provider business mailing address

5811 28TH ST E UNIT 208
ELLENTON FL
34222-7379
US

V. Phone/Fax

Practice location:
  • Phone: 941-336-6648
  • Fax:
Mailing address:
  • Phone: 636-675-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: