Provider Demographics
NPI:1609836725
Name:MYERS, DENNIS LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LANE
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 1:1503 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2911
Mailing Address - Country:US
Mailing Address - Phone:252-438-2273
Mailing Address - Fax:252-738-0001
Practice Address - Street 1:1503 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2911
Practice Address - Country:US
Practice Address - Phone:252-438-2273
Practice Address - Fax:252-738-0001
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890838GMedicaid
NCU67741Medicare UPIN
NC890838GMedicaid
NC2453959Medicare ID - Type UnspecifiedMEDICARE NUMBER
NC2453989AMedicare PIN