Provider Demographics
NPI:1164793451
Name:MERRITT CHIROPRACTIC OFFICE INC
Entity Type:Organization
Organization Name:MERRITT CHIROPRACTIC OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TOWNSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-220-2282
Mailing Address - Street 1:500 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3014
Mailing Address - Country:US
Mailing Address - Phone:772-220-2282
Mailing Address - Fax:772-220-4773
Practice Address - Street 1:500 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3014
Practice Address - Country:US
Practice Address - Phone:772-220-2282
Practice Address - Fax:772-220-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU29563Medicare UPIN