Provider Demographics
NPI:1619932431
Name:MEYER, SHAWN MICHAEL (DC, CCN, PMMTP)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:MEYER
Suffix:
Gender:M
Credentials:DC, CCN, PMMTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 N SCOTTSDALE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3635
Mailing Address - Country:US
Mailing Address - Phone:480-609-4244
Mailing Address - Fax:
Practice Address - Street 1:4110 N SCOTTSDALE RD STE 215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3635
Practice Address - Country:US
Practice Address - Phone:480-609-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7589111NN1001X
AZ4276225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0945690OtherBLUE CROSS BLUE SHIELD
AZ202901918OtherFEDERAL TAX ID
AZ202901918OtherFEDERAL TAX ID