Basic Information
| Provider Information | |||||||||
| NPI: | 1003002486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINNER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1115 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630903303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362399997 | ||||||||
| FaxNumber: | 6362399931 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630903303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362399997 | ||||||||
| FaxNumber: | 6362399931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2007027755 | MO | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1100652 | 01 | MO | CIGNA PIN | OTHER | 261152778MIN | 01 | MO | MERCY PIN | OTHER | 714177 | 01 | MO | UNITED HEALTHCARE PIN | OTHER | 9058107 | 01 | MO | AETNA PIN | OTHER |