Provider Demographics
NPI:1164423349
Name:MEYLOR, LEE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANTHONY
Last Name:MEYLOR
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:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-0334
Mailing Address - Country:US
Mailing Address - Phone:712-732-7280
Mailing Address - Fax:712-732-7281
Practice Address - Street 1:1411 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2683
Practice Address - Country:US
Practice Address - Phone:712-732-7280
Practice Address - Fax:712-732-7281
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0213041Medicaid
IA0213041Medicaid
IA21304Medicare ID - Type Unspecified