Provider Demographics
NPI:1558427112
Name:MEYER, CAROL ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:MEYER
Other - Last Name:ZOELLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:133 S STATE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1134
Mailing Address - Country:US
Mailing Address - Phone:801-773-4944
Mailing Address - Fax:
Practice Address - Street 1:133 S STATE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1134
Practice Address - Country:US
Practice Address - Phone:801-773-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4776735-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47767351200001OtherFEDERAL BLUE CROSS PROVIDER ID