Provider Demographics
NPI:1255481453
Name:MERCER HEALTH INC
Entity Type:Organization
Organization Name:MERCER HEALTH INC
Other - Org Name:MANNFORD CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-865-8811
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044
Mailing Address - Country:US
Mailing Address - Phone:918-865-8811
Mailing Address - Fax:918-865-8812
Practice Address - Street 1:150 E COONROD AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044
Practice Address - Country:US
Practice Address - Phone:918-865-8811
Practice Address - Fax:918-865-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47176Medicare UPIN