Provider Demographics
NPI:1609890821
Name:MYERS, RICHARD EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWIN
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 1:1100 WAYNE ST
Mailing Address - Street 2:SUITE 1460
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3048
Mailing Address - Country:US
Mailing Address - Phone:937-335-8534
Mailing Address - Fax:937-335-4546
Practice Address - Street 1:1100 WAYNE ST
Practice Address - Street 2:SUITE 1460
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3048
Practice Address - Country:US
Practice Address - Phone:937-335-8534
Practice Address - Fax:937-335-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2389366Medicaid
OH2389366Medicaid
OHU95643Medicare UPIN