Provider Demographics
NPI:1598921801
Name:MYERS, JEFFREY TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
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:PO BOX 891
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-0891
Mailing Address - Country:US
Mailing Address - Phone:307-388-2341
Mailing Address - Fax:307-347-3267
Practice Address - Street 1:526 BIG HORN ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2342
Practice Address - Country:US
Practice Address - Phone:307-388-2341
Practice Address - Fax:307-347-3267
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU9734Medicare UPIN