Provider Demographics
NPI:1750754263
Name:MEYERS, ALYSE (LAC)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-1536
Mailing Address - Country:US
Mailing Address - Phone:515-341-5076
Mailing Address - Fax:
Practice Address - Street 1:1519 S PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3649
Practice Address - Country:US
Practice Address - Phone:515-295-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-92171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist