Provider Demographics
NPI:1700075066
Name:MEYER, CHRISTIAN NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:NICHOLAS
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 1:3019 SCHNEIDER AVE SE
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2997
Mailing Address - Country:US
Mailing Address - Phone:715-556-0177
Mailing Address - Fax:715-235-6108
Practice Address - Street 1:3019 SCHNEIDER AVE SE
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2997
Practice Address - Country:US
Practice Address - Phone:715-556-0177
Practice Address - Fax:715-235-6108
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor