Provider Demographics
NPI:1588105605
Name:MERRILL, DANIEL (MED, ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MERRILL
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7153
Mailing Address - Country:US
Mailing Address - Phone:219-662-1159
Mailing Address - Fax:
Practice Address - Street 1:11515 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7153
Practice Address - Country:US
Practice Address - Phone:219-662-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer