MEDICARE: DR. JONATHAN MEYLOR D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1731	NE
2	111N00000X	Chiropractor	007586	IA

General Provider Information

NPI Number	:	1093063497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MEYLOR D.C.

Provider Business Mailing Address
First Line	:	9633 GILES RD
Second Line	:
City	:	LA VISTA
State	:	NE
Zip	:	68128-2928
Country	:	US
Telephone Number	:	712-261-0424
Fax Number	:

Provider Business Practice Location Address
First Line	:	9633 GILES RD
Second Line	:
City	:	LA VISTA
State	:	NE
Zip	:	68128-2928
Country	:	US
Telephone Number	:	712-261-0424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	01/09/2013

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