Provider Demographics
NPI:1154317832
Name:MYERS, JAMES DWIGHT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DWIGHT
Last Name:MYERS
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 1:115 W LAWRENCE AVE
Mailing Address - Street 2:POST OFFICE BOX 436
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1404
Mailing Address - Country:US
Mailing Address - Phone:517-543-5411
Mailing Address - Fax:
Practice Address - Street 1:115 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1404
Practice Address - Country:US
Practice Address - Phone:517-543-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B35008OtherBCBS OF MI
MIT98811Medicare UPIN
MI0M70620Medicare PIN