Provider Demographics
NPI:1538222179
Name:MYERS, FOTINE SOPHIA (DC)
Entity type:Individual
Prefix:DR
First Name:FOTINE
Middle Name:SOPHIA
Last Name:MYERS
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 1:5041 SIX FORKS RD
Mailing Address - Street 2:STE: 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4493
Mailing Address - Country:US
Mailing Address - Phone:919-786-9996
Mailing Address - Fax:919-786-9676
Practice Address - Street 1:5041 SIX FORKS RD
Practice Address - Street 2:STE: 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4493
Practice Address - Country:US
Practice Address - Phone:919-848-6188
Practice Address - Fax:919-848-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU71226Medicare UPIN