Provider Demographics
NPI:1144264219
Name:MEYER, BRUCE ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:MEYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2483 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2501
Mailing Address - Country:US
Mailing Address - Phone:718-332-8888
Mailing Address - Fax:718-332-8888
Practice Address - Street 1:2483 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2501
Practice Address - Country:US
Practice Address - Phone:718-332-8888
Practice Address - Fax:718-332-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-2804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY616611OtherACN GROUP
NY814020OtherMANAGED PHYSICAL NETWORK
NYP771084OtherOXFORD
NY000129196001OtherUNITED HEALTH CARE
NY4321324OtherAETNA POS
NY0479327OtherAETNA HMO
NY4321324OtherAETNA PPO
NY616611OtherACN GROUP
NYX15611Medicare ID - Type UnspecifiedMEDICARE ID NUMBER