Provider Demographics
NPI:1427173673
Name:NEWMYER, ELDON LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:LEE
Last Name:NEWMYER
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 1:127 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8250
Mailing Address - Country:US
Mailing Address - Phone:269-795-7096
Mailing Address - Fax:269-795-8846
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8250
Practice Address - Country:US
Practice Address - Phone:269-795-7096
Practice Address - Fax:269-795-8846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OZ810230OtherBLUE CROSS BLUE SHIELD
MI95OZ810230OtherBLUE CROSS BLUE SHIELD