Provider Demographics
NPI:1346508488
Name:MYERS CHIROPRACTIC CLINIC DC PC
Entity Type:Organization
Organization Name:MYERS CHIROPRACTIC CLINIC DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-497-5555
Mailing Address - Street 1:3039 ALLISON BONNETT MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2397
Mailing Address - Country:US
Mailing Address - Phone:205-497-5555
Mailing Address - Fax:205-497-5557
Practice Address - Street 1:3039 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2397
Practice Address - Country:US
Practice Address - Phone:205-497-5555
Practice Address - Fax:205-497-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070451MYEOtherBCBS OF AL
AL51070451MYEOtherBCBS OF AL