Provider Demographics
NPI:1386709566
Name:MERRITT CHIROPRACTIC PC
Entity type:Organization
Organization Name:MERRITT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-359-7298
Mailing Address - Street 1:2213 E 52ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2785
Mailing Address - Country:US
Mailing Address - Phone:563-359-7298
Mailing Address - Fax:563-359-4469
Practice Address - Street 1:2213 E 52ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2785
Practice Address - Country:US
Practice Address - Phone:563-359-7298
Practice Address - Fax:563-359-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10013OtherWELMARK
IA0454397Medicaid
IAU35781Medicare UPIN
IAI14650Medicare ID - Type Unspecified