Provider Demographics
NPI:1134213622
Name:MYERS, RACHELLE MARIE JEANNE (DC)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:MARIE JEANNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:M
Other - Last Name:BOUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014
Mailing Address - Country:US
Mailing Address - Phone:269-964-1441
Mailing Address - Fax:269-964-0137
Practice Address - Street 1:1250 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014
Practice Address - Country:US
Practice Address - Phone:269-964-1441
Practice Address - Fax:269-964-0137
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
MI2301008187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P25671FOtherBCN
MI4474514Medicaid
N2215003Medicare ID - Type Unspecified
MI4474514Medicaid