Basic Information
Provider Information | |||||||||
NPI: | 1548381064 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOODRUFF-DISHMAN | ||||||||
FirstName: | MEAGHAN | ||||||||
MiddleName: | HALL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ND, LAC, MSOM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DISHMAN | ||||||||
OtherFirstName: | MEAGHAN | ||||||||
OtherMiddleName: | HALL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ND, LAC, MSOM | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 3313 NW SHEVLIN RDG | ||||||||
Address2: |   | ||||||||
City: | BEND | ||||||||
State: | OR | ||||||||
PostalCode: | 977037752 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193971012 | ||||||||
FaxNumber: | 8883049394 | ||||||||
Practice Location | |||||||||
Address1: | 550 SW INDUSTRIAL WAY, BUILDING 2 | ||||||||
Address2: | SUITE 100 | ||||||||
City: | BEND | ||||||||
State: | OR | ||||||||
PostalCode: | 97702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5413129838 | ||||||||
FaxNumber: | 5413129839 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/02/2007 | ||||||||
LastUpdateDate: | 01/11/2019 | ||||||||
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 | 171100000X | 596 | NC | N |   | Other Service Providers | Acupuncturist |   | 171100000X | AC00910 | OR | N |   | Other Service Providers | Acupuncturist |   | 175F00000X | 1446 | OR | Y |   | Other Service Providers | Naturopath |   |
No ID Information.