Provider Demographics
NPI:1649337288
Name:MEYER, JODI (DC, BSC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:DC, BSC
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, BSC
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-1201
Mailing Address - Country:US
Mailing Address - Phone:509-422-1054
Mailing Address - Fax:509-422-1054
Practice Address - Street 1:21 FOURTH AVE. WEST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-1201
Practice Address - Country:US
Practice Address - Phone:509-422-1054
Practice Address - Fax:509-422-1054
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8460974Medicaid
WA8460974Medicaid