Provider Demographics
NPI:1225211915
Name:MERRICK, VICKI M (DC)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:M
Last Name:MERRICK
Suffix:
Gender:F
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:PO BOX 100246
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32910-0246
Mailing Address - Country:US
Mailing Address - Phone:321-952-7004
Mailing Address - Fax:321-952-1004
Practice Address - Street 1:2060 PALM BAY RD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2931
Practice Address - Country:US
Practice Address - Phone:321-952-7004
Practice Address - Fax:321-952-1004
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050925600Medicaid
FL267605OtherWELLCARE
22774Medicare PIN
U206565Medicare UPIN