Provider Demographics
NPI:1043430697
Name:MERRIT, MARVIN J (DC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:J
Last Name:MERRIT
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 1:1000 E ATLANTIC BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7447
Mailing Address - Country:US
Mailing Address - Phone:954-968-4144
Mailing Address - Fax:
Practice Address - Street 1:1433 SW 26TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4315
Practice Address - Country:US
Practice Address - Phone:954-968-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650930328OtherTAX ID
FLT55077Medicare UPIN
FL70945AMedicare ID - Type Unspecified