Provider Demographics
NPI:1245436856
Name:MAYERS, ANTOINETTE MONIQUE (DC)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MONIQUE
Last Name:MAYERS
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 1:1223 LAMAR AVE
Mailing Address - Street 2:P.O. BOX 1455
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2954
Mailing Address - Country:US
Mailing Address - Phone:662-528-0517
Mailing Address - Fax:662-746-4772
Practice Address - Street 1:1223 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2954
Practice Address - Country:US
Practice Address - Phone:662-528-0517
Practice Address - Fax:662-746-4772
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor