Provider Demographics
NPI:1255585188
Name:MYERS FAMILY CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:MYERS FAMILY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-866-7041
Mailing Address - Street 1:8645 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-4722
Mailing Address - Country:US
Mailing Address - Phone:814-866-7041
Mailing Address - Fax:814-866-6615
Practice Address - Street 1:8645 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4722
Practice Address - Country:US
Practice Address - Phone:814-866-7041
Practice Address - Fax:814-866-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009630111N00000X
PADC006633L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015765480003Medicaid
PA1031332460001Medicaid
PAU61133Medicare UPIN