Provider Demographics
NPI:1942393756
Name:MEYER, MATTHEW BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRENT
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 1:1707 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3618
Mailing Address - Country:US
Mailing Address - Phone:563-324-3817
Mailing Address - Fax:563-324-1714
Practice Address - Street 1:1707 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3618
Practice Address - Country:US
Practice Address - Phone:563-324-3817
Practice Address - Fax:563-324-1714
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU71064Medicare UPIN