Healthcare Provider Details

I. General information

NPI: 1356123236
Provider Name (Legal Business Name): CHEYENNE MEGALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHEYENNE FRANKLIN

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 S MAIN ST STE 3
ADRIAN MI
49221-4309
US

IV. Provider business mailing address

1424 S MAIN ST STE 3
ADRIAN MI
49221-4309
US

V. Phone/Fax

Practice location:
  • Phone: 517-312-1710
  • Fax: 517-507-3714
Mailing address:
  • Phone: 517-312-1710
  • Fax: 517-507-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-546153
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: