Healthcare Provider Details

I. General information

NPI: 1891158226
Provider Name (Legal Business Name): MEAGEN MATEIALONA BS, MS, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S SAGINAW ST STE 4
SAINT CHARLES MI
48655-1452
US

IV. Provider business mailing address

115 S SAGINAW ST STE 4
SAINT CHARLES MI
48655-1452
US

V. Phone/Fax

Practice location:
  • Phone: 989-865-6100
  • Fax:
Mailing address:
  • Phone: 989-865-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010299
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: