Provider Demographics
NPI:1417926064
Name:MYERS, MARK AARON (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:AARON
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 1:416 E ROOSEVELT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:630-868-8480
Mailing Address - Fax:630-868-8372
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:STE 101
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-868-8480
Practice Address - Fax:630-868-8372
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00126227OtherRR MEDICARE
IL02232122OtherBCBSIL
ILP00126227OtherRR MEDICARE
U91963Medicare UPIN