Provider Demographics
NPI:1710955331
Name:MIERS, DOUGLAS ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:MIERS
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:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-0933
Mailing Address - Country:US
Mailing Address - Phone:419-468-1036
Mailing Address - Fax:419-462-5335
Practice Address - Street 1:218 PORTLAND WAY N
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1631
Practice Address - Country:US
Practice Address - Phone:419-468-1036
Practice Address - Fax:419-462-5335
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1583111N00000X
MI2301005770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0852573Medicaid
000000136869OtherANTHEM
000000136869OtherANTHEM
MI0705921Medicare ID - Type Unspecified