Provider Demographics
NPI:1063638039
Name:MERRILL-RINALDI CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:MERRILL-RINALDI CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:JULES
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-724-5625
Mailing Address - Street 1:152 N HARBOR CITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6794
Mailing Address - Country:US
Mailing Address - Phone:321-242-2676
Mailing Address - Fax:321-242-2675
Practice Address - Street 1:152 N HARBOR CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6794
Practice Address - Country:US
Practice Address - Phone:321-242-2676
Practice Address - Fax:321-242-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40736OtherGROUP BCBS
FL70679OtherBCBS RINALDI
FL70678OtherBCBS MERRILL
FL70678OtherBCBS MERRILL
FL70679OtherBCBS RINALDI
FLT85481Medicare UPIN