Provider Demographics
NPI:1528396439
Name:MEYERS, PHILLIP ROBERT
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ROBERT
Last Name:MEYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14256 WILLOW BEND PARK
Mailing Address - Street 2:APT6
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8268
Mailing Address - Country:US
Mailing Address - Phone:636-236-9848
Mailing Address - Fax:
Practice Address - Street 1:14256 WILLOW BEND PARK
Practice Address - Street 2:APT6
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8268
Practice Address - Country:US
Practice Address - Phone:636-236-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009025576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor