=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346446085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEYER POE, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5773 EGAN DR
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-4917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-440-4332
-----------------------------------------------------
Fax | 952-440-4344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5773 EGAN DR
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-4917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-440-4332
-----------------------------------------------------
Fax | 952-440-4344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TERRY POE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-440-4332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3822
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------