MEDICARE: KEVIN WILLIAM MEYER 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	2021002449	MO

General Provider Information

NPI Number	:	1942890165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WILLIAM MEYER DC

Provider Business Mailing Address
First Line	:	113 FOREST PKWY APT F
Second Line	:
City	:	VALLEY PARK
State	:	MO
Zip	:	63088-1032
Country	:	US
Telephone Number	:	812-664-5611
Fax Number	:

Provider Business Practice Location Address
First Line	:	13327 MANCHESTER RD
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-1710
Country	:	US
Telephone Number	:	314-701-7660
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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