=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225333933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW PAUL MEEHAN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2011
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7050 BIDDULPH RD
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44144-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-749-7888
-----------------------------------------------------
Fax | 216-749-6660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7050 BIDDULPH RD
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44144-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-749-7888
-----------------------------------------------------
Fax | 216-749-6660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4124
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------