Provider Demographics
NPI:1659592475
Name:MEYERS, DAVID MICHAEL (DC,CCSP,QME,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MEYERS
Suffix:
Gender:M
Credentials:DC,CCSP,QME,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WEST F STREET
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361
Mailing Address - Country:US
Mailing Address - Phone:209-847-2021
Mailing Address - Fax:209-847-7524
Practice Address - Street 1:715 WEST F STREET
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-847-2021
Practice Address - Fax:209-847-7524
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23555111NS0005X
AZ8467111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65238ZOtherBLUE SHIELD
CADC23555OtherSTATE LICENSE
CAZZZ65238ZOtherBLUE SHIELD