Provider Demographics
NPI:1063438976
Name:MCCONNELL, MEGAN DENNEY (DC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:DENNEY
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510
Mailing Address - Country:US
Mailing Address - Phone:707-745-2345
Mailing Address - Fax:707-745-4245
Practice Address - Street 1:1075 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3200
Practice Address - Country:US
Practice Address - Phone:707-745-2345
Practice Address - Fax:707-745-4245
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0276240Medicare ID - Type Unspecified
U88883Medicare UPIN