Provider Demographics
NPI:1528747052
Name:DANIELS, MEGAN ANN (LAC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4539 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3026
Mailing Address - Country:US
Mailing Address - Phone:847-309-3503
Mailing Address - Fax:
Practice Address - Street 1:700 E OGDEN AVE STE 304
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5554
Practice Address - Country:US
Practice Address - Phone:847-309-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist