Healthcare Provider Details

I. General information

NPI: 1588992135
Provider Name (Legal Business Name): MEAGHAN VICTORIA CLEMENS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 N HALSTED ST
CHICAGO IL
60657-9492
US

IV. Provider business mailing address

3444 N HALSTED ST
CHICAGO IL
60657-9492
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-9100
  • Fax: 773-525-9105
Mailing address:
  • Phone: 773-525-9100
  • Fax: 773-525-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: