Provider Demographics
NPI:1639176647
Name:MEYERS, SAMUEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBERT
Last Name:MEYERS
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 1:4800 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3817
Mailing Address - Country:US
Mailing Address - Phone:727-528-1133
Mailing Address - Fax:727-527-3750
Practice Address - Street 1:4800 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3817
Practice Address - Country:US
Practice Address - Phone:727-528-1133
Practice Address - Fax:727-527-3750
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382075100Medicaid
FLU7753ZMedicare ID - Type Unspecified
FL382075100Medicaid