Provider Demographics
NPI:1285818294
Name:MERCADO, RHYAN KIEVEL (DC)
Entity type:Individual
Prefix:DR
First Name:RHYAN
Middle Name:KIEVEL
Last Name:MERCADO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1713
Mailing Address - Country:US
Mailing Address - Phone:570-654-0036
Mailing Address - Fax:570-654-7890
Practice Address - Street 1:84 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1713
Practice Address - Country:US
Practice Address - Phone:570-654-0036
Practice Address - Fax:570-654-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ009694111N00000X
PADC009878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor