MEDICARE: DR. JOHN J MEYER 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	DC2954	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7266029	OTHER	TX	AETNA
2	601200	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1639170483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J MEYER D.C.

Provider Business Mailing Address
First Line	:	804 N SAINT MARYS ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-4046
Country	:	US
Telephone Number	:	361-358-4151
Fax Number	:	361-358-7059

Provider Business Practice Location Address
First Line	:	804 N SAINT MARYS ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-4046
Country	:	US
Telephone Number	:	361-358-4151
Fax Number	:	361-358-7059

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/09/2007

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