Healthcare Provider Details

I. General information

NPI: 1801877485
Provider Name (Legal Business Name): THOMAS PATRICK MEEHAN JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13544 US ROUTE 30 SUITE D
PLAINFIELD IL
60544-5149
US

IV. Provider business mailing address

PO BOX 418
PLAINFIELD IL
60544-0418
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-3707
  • Fax: 815-367-3709
Mailing address:
  • Phone: 815-267-3707
  • Fax: 815-267-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9932237
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: