Provider Demographics
NPI:1003993395
Name:GEIYER, MISTY ANN (DC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:GEIYER
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 1:655H FAIRVIEW RD # 255
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6706
Mailing Address - Country:US
Mailing Address - Phone:864-962-5504
Mailing Address - Fax:864-967-3788
Practice Address - Street 1:215 N MAIN ST UNIT 2A
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2342
Practice Address - Country:US
Practice Address - Phone:864-962-5504
Practice Address - Fax:864-967-3788
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2546Medicaid