Provider Demographics
NPI:1649263062
Name:MAYER, WILLIAM ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MAYER
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 1:210 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1763
Mailing Address - Country:US
Mailing Address - Phone:239-574-8000
Mailing Address - Fax:239-574-1004
Practice Address - Street 1:210 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 3
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1763
Practice Address - Country:US
Practice Address - Phone:239-574-8000
Practice Address - Fax:239-574-1004
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC056988OtherNY/WC
FL350055843OtherMEDICARE RAILROAD
FL22840OtherBCBS
FLU38949Medicare UPIN
FL22840Medicare ID - Type Unspecified