Provider Demographics
NPI:1124219951
Name:MERRITT, RICHARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:MERRITT
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 1:1253 W MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-0602
Mailing Address - Country:US
Mailing Address - Phone:863-687-8165
Mailing Address - Fax:863-687-1807
Practice Address - Street 1:1001 TATE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4334
Practice Address - Country:US
Practice Address - Phone:334-446-3101
Practice Address - Fax:334-446-6237
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89929ZMedicare PIN
FLT88898Medicare UPIN
FL89929Medicare PIN