Provider Demographics
NPI:1063825420
Name:MERRIAM CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:MERRIAM CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-232-7588
Mailing Address - Street 1:5103 MERRIAM DR
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2167
Mailing Address - Country:US
Mailing Address - Phone:913-232-7588
Mailing Address - Fax:913-232-7593
Practice Address - Street 1:5103 MERRIAM DR
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-2167
Practice Address - Country:US
Practice Address - Phone:913-232-7588
Practice Address - Fax:913-232-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty