Provider Demographics
NPI:1124314406
Name:BIRT, MEGHAN SHOGREN (DC)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:SHOGREN
Last Name:BIRT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:SHOGREN
Other - Last Name:BANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8675 MARIGOLD CIR
Mailing Address - Street 2:#106
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7657
Mailing Address - Country:US
Mailing Address - Phone:918-327-9610
Mailing Address - Fax:763-425-2676
Practice Address - Street 1:8509 JEFFERSON LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2119
Practice Address - Country:US
Practice Address - Phone:763-425-4577
Practice Address - Fax:763-425-2676
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor