Provider Demographics
NPI:1972293215
Name:MATTOX, MEGAN RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RENEE
Last Name:MATTOX
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 1:4230 S WESTNEDGE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3291
Mailing Address - Country:US
Mailing Address - Phone:269-254-8419
Mailing Address - Fax:
Practice Address - Street 1:4230 S WESTNEDGE AVE STE 4
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3291
Practice Address - Country:US
Practice Address - Phone:269-254-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor