Provider Demographics
NPI:1013131788
Name:MYERS, MICHAEL ROSS (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
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 1:450 N PARK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6917
Mailing Address - Country:US
Mailing Address - Phone:954-986-4559
Mailing Address - Fax:
Practice Address - Street 1:450 N PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6917
Practice Address - Country:US
Practice Address - Phone:954-986-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16-1735258Medicare UPIN