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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 19773 | Medicaid |