Provider Demographics
NPI:1073099537
Name:MEYSTER, VITALIY S (DC)
Entity Type:Individual
Prefix:
First Name:VITALIY
Middle Name:S
Last Name:MEYSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FAIRWAY DR APT 1H
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3091
Mailing Address - Country:US
Mailing Address - Phone:630-400-8109
Mailing Address - Fax:
Practice Address - Street 1:1601 FAIRWAY DR APT 1H
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3091
Practice Address - Country:US
Practice Address - Phone:630-400-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor