1255585188 NPI number — MYERS FAMILY CHIROPRACTIC CENTER, LLC

Table of content: (NPI 1255585188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255585188 NPI number — MYERS FAMILY CHIROPRACTIC CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MYERS FAMILY CHIROPRACTIC CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255585188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8645 PEACH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16509-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-866-7041
Provider Business Mailing Address Fax Number:
814-866-6615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8645 PEACH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-866-7041
Provider Business Practice Location Address Fax Number:
814-866-6615
Provider Enumeration Date:
11/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
OWNER/DC
Authorized Official Telephone Number:
814-866-7041

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009630 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC006633L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1031332460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015765480003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".