Provider Demographics
NPI:1770995581
Name:MEYER, PAULINE BETH (DC)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:BETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAULINE
Other - Middle Name:BETH
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:307 CRESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3739
Mailing Address - Country:US
Mailing Address - Phone:612-718-5515
Mailing Address - Fax:
Practice Address - Street 1:307 CRESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677
Practice Address - Country:US
Practice Address - Phone:612-718-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor