Provider Demographics
NPI:1649709221
Name:MEYER, DUSTIN (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MEYER
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 1:11197 N FRIAR DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8502
Mailing Address - Country:US
Mailing Address - Phone:816-605-5050
Mailing Address - Fax:
Practice Address - Street 1:311 EAST COEUR D'ALENE AVE SUITE B
Practice Address - Street 2:
Practice Address - City:COEUR D' ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:816-605-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor