Healthcare Provider Details

I. General information

NPI: 1497784011
Provider Name (Legal Business Name): MEGAN BLOUNT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST SUITE 102
DE FOREST WI
53532-1163
US

IV. Provider business mailing address

210 N MAIN ST SUITE 102
DE FOREST WI
53532-1163
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-2454
  • Fax: 608-846-2404
Mailing address:
  • Phone: 608-846-2454
  • Fax: 608-846-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3744-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: