=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326102955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEYER CHIROPRACTIC CLINIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 02/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 GRAND AVE STE 200
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-4291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-222-1911
-----------------------------------------------------
Fax | 515-222-1912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 GRAND AVE STE 200
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-4291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-222-1911
-----------------------------------------------------
Fax | 515-222-1912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TODD ALLAN MEYER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 515-222-1911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | A5441
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------