Provider Demographics
NPI:1619131026
Name:MYERS, BRUCE D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
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 1:9905 N DAVIDSON PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4200
Mailing Address - Country:US
Mailing Address - Phone:770-474-1421
Mailing Address - Fax:770-474-3704
Practice Address - Street 1:9905 N DAVIDSON PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4200
Practice Address - Country:US
Practice Address - Phone:770-474-1421
Practice Address - Fax:770-474-3704
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU47191Medicare UPIN
GA35ZCGHWMedicare PIN