Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 13108 | TX |
Y | 111NP0017X | Pediatric Chiropractor | 13108 | TX |
NPI | 1770942286 |
---|---|
Provider Name | Dr. Meghan Irene Blankenship |
First Address | Wylie, TX 75098-4495 |
Second Address | Wylie, TX 75098-4495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2016 |
Last Update Date | 12/02/2016 |