Provider Demographics
NPI:1114064037
Name:MYERS, BOBBY L II (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:L
Last Name:MYERS
Suffix:II
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 1:830 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6265
Mailing Address - Country:US
Mailing Address - Phone:901-752-8883
Mailing Address - Fax:901-752-8843
Practice Address - Street 1:830 N GERMANTOWN PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6265
Practice Address - Country:US
Practice Address - Phone:901-752-8883
Practice Address - Fax:901-752-8843
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7954505OtherAETNA HEALTHCARE
TN4069895OtherBLUE CROSS BLUE SHIELD
TN6764463OtherCIGNA HEALTHCARE
TN4069895OtherBLUE CROSS BLUE SHIELD
TNV07363Medicare UPIN