Provider Demographics
NPI:1922871540
Name:MYERS, DRISTIN (DC)
Entity Type:Individual
Prefix:
First Name:DRISTIN
Middle Name:
Last Name:MYERS
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 1:5609 SW GREEN OAKS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1153
Mailing Address - Country:US
Mailing Address - Phone:817-483-3975
Mailing Address - Fax:
Practice Address - Street 1:5609 SW GREEN OAKS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1153
Practice Address - Country:US
Practice Address - Phone:817-483-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor