Healthcare Provider Details

I. General information

NPI: 1689217994
Provider Name (Legal Business Name): MEGHAN ANGELA ISENMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
CAPE GIRARDEAU MO
63701-4710
US

IV. Provider business mailing address

1663 KIRKHAM DR
ARNOLD MO
63010-1925
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-2000
  • Fax:
Mailing address:
  • Phone: 314-971-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2025000591
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: