Healthcare Provider Details

I. General information

NPI: 1063705192
Provider Name (Legal Business Name): MEGAN LEE HOLLEY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S VAN BUREN ST
SHIPSHEWANA IN
46565-9098
US

IV. Provider business mailing address

660 S VAN BUREN ST
SHIPSHEWANA IN
46565-9098
US

V. Phone/Fax

Practice location:
  • Phone: 260-768-4333
  • Fax:
Mailing address:
  • Phone: 260-768-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002582A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: