Provider Demographics
NPI:1417273665
Name:MEYER CHIROPRACTIC HEALTH CLINIC
Entity Type:Organization
Organization Name:MEYER CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-972-9355
Mailing Address - Street 1:128 RIVER ST N
Mailing Address - Street 2:PO BOX 748
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9311
Mailing Address - Country:US
Mailing Address - Phone:763-972-9355
Mailing Address - Fax:763-972-2315
Practice Address - Street 1:128 RIVER ST N
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-9311
Practice Address - Country:US
Practice Address - Phone:763-972-9355
Practice Address - Fax:763-972-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263690500Medicaid
MN263690500Medicaid