Provider Demographics
NPI:1467751966
Name:KENNETH MYERS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:KENNETH MYERS CHIROPRACTIC CORPORATION
Other - Org Name:SAN ANTONIO PAIN RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-945-8721
Mailing Address - Street 1:9033 BASELINE RD
Mailing Address - Street 2:Q
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1255
Mailing Address - Country:US
Mailing Address - Phone:909-945-8721
Mailing Address - Fax:909-980-9301
Practice Address - Street 1:9033 BASELINE RD
Practice Address - Street 2:Q
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1255
Practice Address - Country:US
Practice Address - Phone:909-945-8721
Practice Address - Fax:909-980-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0294550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty