Provider Demographics
NPI:1891815742
Name:MYERS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:MYERS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-942-3505
Mailing Address - Street 1:3244 WASHINGTON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3153
Mailing Address - Country:US
Mailing Address - Phone:724-344-6993
Mailing Address - Fax:724-942-4718
Practice Address - Street 1:3244 WASHINGTON RD STE 205
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3153
Practice Address - Country:US
Practice Address - Phone:724-942-3505
Practice Address - Fax:724-942-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005683L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA195029OtherBLUE SHIELD
PA757552Medicare ID - Type Unspecified