Provider Demographics
NPI:1265279046
Name:MYERS, BRODY
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 N STATE ROAD 1 STE 1A
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777-8973
Mailing Address - Country:US
Mailing Address - Phone:260-409-8200
Mailing Address - Fax:
Practice Address - Street 1:7145 N STATE ROAD 1 STE 1A
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777-8973
Practice Address - Country:US
Practice Address - Phone:260-409-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003434A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor