Provider Demographics
NPI:1558360867
Name:MYERS, BRETT ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ANDREW
Last Name:MYERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E MILHAM AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3096
Mailing Address - Country:US
Mailing Address - Phone:269-381-2200
Mailing Address - Fax:269-381-4233
Practice Address - Street 1:1125 E MILHAM AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3096
Practice Address - Country:US
Practice Address - Phone:269-381-2200
Practice Address - Fax:269-381-4233
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-12-03
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MI2301008592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4430218OtherIBA/PHP
MI144724125Medicaid
MI950A310950OtherBLUE CROSS BLUE SHIELD
MI230002000OtherUS DEPT OF LABOR
MI950A310950OtherBLUE CROSS BLUE SHIELD
MI230002000OtherUS DEPT OF LABOR