Provider Demographics
NPI:1992905145
Name:MYHERS CHIROPRACTIC INC
Entity type:Organization
Organization Name:MYHERS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-597-3388
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-0336
Mailing Address - Country:US
Mailing Address - Phone:715-597-3388
Mailing Address - Fax:715-597-2688
Practice Address - Street 1:13818 7TH ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-7402
Practice Address - Country:US
Practice Address - Phone:715-597-3388
Practice Address - Fax:715-597-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3101-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3889100Medicaid
WIU56702Medicare UPIN