Provider Demographics
NPI:1164501284
Name:MEAD, MERRITT G (DC)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:G
Last Name:MEAD
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 1:12022 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3548
Mailing Address - Country:US
Mailing Address - Phone:310-675-6279
Mailing Address - Fax:310-675-7577
Practice Address - Street 1:12022 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3548
Practice Address - Country:US
Practice Address - Phone:310-675-6279
Practice Address - Fax:310-675-7577
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC 8457Medicare ID - Type Unspecified
T18888Medicare UPIN