Healthcare Provider Details

I. General information

NPI: 1053966804
Provider Name (Legal Business Name): MEAGHAN MCGINNITY LONGYEAR DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 PERIMETER PARK BLVD STE 102
JACKSONVILLE FL
32216-2287
US

IV. Provider business mailing address

8750 PERIMETER PARK BLVD STE 102
JACKSONVILLE FL
32216-2287
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-1477
  • Fax:
Mailing address:
  • Phone: 904-900-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12947
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: