Provider Demographics
NPI:1861619744
Name:MEYER CHIROPRACTIC CENTER, CHTD.
Entity type:Organization
Organization Name:MEYER CHIROPRACTIC CENTER, CHTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-634-6111
Mailing Address - Street 1:17 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1161
Mailing Address - Country:US
Mailing Address - Phone:507-634-6111
Mailing Address - Fax:507-634-7475
Practice Address - Street 1:17 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1161
Practice Address - Country:US
Practice Address - Phone:507-634-6111
Practice Address - Fax:507-634-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC06826Medicare PIN
MNT-65862Medicare UPIN