Provider Demographics
NPI:1023587672
Name:WHITE, MEGAN NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3535 CLINIC RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1997
Mailing Address - Country:US
Mailing Address - Phone:608-365-1656
Mailing Address - Fax:608-365-2250
Practice Address - Street 1:3535 CLINIC RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1997
Practice Address - Country:US
Practice Address - Phone:608-365-1656
Practice Address - Fax:608-365-2250
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5410-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor