MEDICARE: DRISTIN MYERS DC

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	1629	HI
2	111N00000X	Chiropractor	15891	TX

General Provider Information

NPI Number	:	1922871540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRISTIN MYERS DC

Provider Business Mailing Address
First Line	:	99-080 KAUHALE ST STE D9
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-4114
Country	:	US
Telephone Number	:	808-637-2608
Fax Number	:	808-748-0161

Provider Business Practice Location Address
First Line	:	4510 SALT LAKE BLVD STE B6
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3171
Country	:	US
Telephone Number	:	808-321-7135
Fax Number	:	808-200-3607

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	05/19/2026

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