Provider Demographics
NPI:1740276708
Name:MYERS, RUSTY L (DC)
Entity type:Individual
Prefix:DR
First Name:RUSTY
Middle Name:L
Last Name:MYERS
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 1:1658 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2552
Mailing Address - Country:US
Mailing Address - Phone:740-450-2225
Mailing Address - Fax:740-450-2226
Practice Address - Street 1:1658 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2552
Practice Address - Country:US
Practice Address - Phone:740-450-2225
Practice Address - Fax:740-450-2226
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2383899Medicaid
OH300022209-00OtherBWC - GROUP
OH311520435OtherID - INDIVIDUAL
OH311520435-00OtherBWC - INDIVIDUAL
OH000000225959OtherANTHEM - INDIVIDUAL
OH000000225960OtherANTHEM - GROUP
OH2005789Medicaid
OH300022209OtherID - GROUP
OH300022209001OtherMEDICAL MUTUAL - GROUP
OH300022209001OtherMEDICAL MUTUAL - GROUP
OHP00162080Medicare ID - Type UnspecifiedRR MEDICARE - INDIV
OH9324151Medicare PIN
OH000000225959OtherANTHEM - INDIVIDUAL
OH311520435-00OtherBWC - INDIVIDUAL