Provider Demographics
NPI:1164609954
Name:CLIFFORD J MEYLOR DC PC
Entity Type:Organization
Organization Name:CLIFFORD J MEYLOR DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-255-5511
Mailing Address - Street 1:MEYLOR CHIRO OFFICE 2608 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4048
Mailing Address - Country:US
Mailing Address - Phone:712-255-5511
Mailing Address - Fax:712-277-1336
Practice Address - Street 1:MEYLOR CHIRO OFFICE 2608 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4048
Practice Address - Country:US
Practice Address - Phone:712-255-5511
Practice Address - Fax:712-277-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0172635Medicaid
IA0172635Medicaid