Provider Demographics
NPI:1487735189
Name:MYERS, AUDREY E (DC)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:E
Last Name:MYERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19A HAINES ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4610
Mailing Address - Country:US
Mailing Address - Phone:302-832-7000
Mailing Address - Fax:
Practice Address - Street 1:19A HAINES ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4610
Practice Address - Country:US
Practice Address - Phone:302-832-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000671111N00000X
NJ38MC00659100111N00000X
PAAJ009601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE721564372OtherTAX ID#
DE1629083282OtherGROUP NPI