Provider Demographics
NPI:1073674883
Name:MERCHANT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MERCHANT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-759-4321
Mailing Address - Street 1:2830 LINDEN STREET
Mailing Address - Street 2:UNIT 5B
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3959
Mailing Address - Country:US
Mailing Address - Phone:610-759-4321
Mailing Address - Fax:610-759-4396
Practice Address - Street 1:106 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-759-4321
Practice Address - Fax:610-759-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002947L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3576462OtherOXFORD
6439672001OtherCIGNA
3767950OtherAETNA
50000380OtherCAPITAL BLUE CROSS
6439672001OtherCIGNA