Provider Demographics
NPI:1740716950
Name:MYERS CHIROPRACTIC
Entity type:Organization
Organization Name:MYERS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-821-4645
Mailing Address - Street 1:12337 S ROUTE 59
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-4625
Mailing Address - Country:US
Mailing Address - Phone:815-267-6263
Mailing Address - Fax:
Practice Address - Street 1:12337 S ROUTE 59
Practice Address - Street 2:SUITE 119
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4625
Practice Address - Country:US
Practice Address - Phone:815-267-6263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty