Provider Demographics
NPI:1942948088
Name:MEYLOR CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MEYLOR CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-564-5121
Mailing Address - Street 1:400 PLYMOUTH ST SW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3443
Mailing Address - Country:US
Mailing Address - Phone:712-546-5121
Mailing Address - Fax:712-546-5023
Practice Address - Street 1:400 PLYMOUTH ST SW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3443
Practice Address - Country:US
Practice Address - Phone:712-546-5121
Practice Address - Fax:712-546-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19773Medicaid