Provider Demographics
NPI:1386764348
Name:MERZ, MARK A (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MERZ
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 1:7077 MARINE RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4281
Mailing Address - Country:US
Mailing Address - Phone:618-656-1111
Mailing Address - Fax:618-659-1111
Practice Address - Street 1:7077 MARINE RD
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4281
Practice Address - Country:US
Practice Address - Phone:618-656-1111
Practice Address - Fax:618-659-1111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006005107OtherBCBS PROVIDER #
IL332650Medicare ID - Type Unspecified