Provider Demographics
NPI:1386884195
Name:MERRILL, STEPHEN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:MERRILL
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 1:16570 HIGHWAY 104 N
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-3847
Mailing Address - Country:US
Mailing Address - Phone:731-249-5640
Mailing Address - Fax:
Practice Address - Street 1:16570 HIGHWAY 104 N
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-3847
Practice Address - Country:US
Practice Address - Phone:731-249-5640
Practice Address - Fax:731-249-5641
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672588Medicare UPIN