MEDICARE: DR. SUSAN MARIE MYERS 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	DC28459	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7213828	OTHER	CA	AETNA
2	DC0284590	OTHER	CA	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1912959958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARIE MYERS D.C.

Provider Business Mailing Address
First Line	:	15294 LIBERTY ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2029
Country	:	US
Telephone Number	:	510-326-2145
Fax Number	:	510-317-9419

Provider Business Practice Location Address
First Line	:	15294 LIBERTY ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2029
Country	:	US
Telephone Number	:	510-326-2145
Fax Number	:	510-317-9419

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/10/2013

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