Provider Demographics
NPI:1689770729
Name:MEYER, NATHAN J (DC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:MEYER
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 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:
Practice Address - Street 1:475 CHIPPEWA MALL DR
Practice Address - Street 2:STE 404
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5034
Practice Address - Country:US
Practice Address - Phone:715-720-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3488-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38906000Medicaid
WI38993300OtherMEDICAID GROUP
WICB3715OtherRAILROAD MEDICARE GROUP
50532OtherSECURITY HEALTH PLAN
50532OtherSECURITY HEALTH PLAN