Provider Demographics
NPI:1063705192
Name:HOLLEY, MEGAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEE
Last Name:HOLLEY
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 1:660 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-9098
Mailing Address - Country:US
Mailing Address - Phone:260-768-4333
Mailing Address - Fax:
Practice Address - Street 1:660 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9098
Practice Address - Country:US
Practice Address - Phone:260-768-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002582A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor