Provider Demographics
NPI:1215960158
Name:MERRICK, JOHN HUMPHREY (DC, PT, MA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUMPHREY
Last Name:MERRICK
Suffix:
Gender:M
Credentials:DC, PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2911
Mailing Address - Country:US
Mailing Address - Phone:603-641-4800
Mailing Address - Fax:603-622-3199
Practice Address - Street 1:1850 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2911
Practice Address - Country:US
Practice Address - Phone:603-641-4800
Practice Address - Fax:603-622-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1088225100000X
NH112-0546-0183A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH080786Y0NH01OtherBLUE CROSS PT #
NH111930OtherCIGNA PT #
NH626548OtherHARVARD PILGRIM PT#
NHRE2195Medicare UPIN
NHU40298Medicare UPIN
NHRE6277Medicare ID - Type UnspecifiedMEDICARE PHYSICAL THER. #