Provider Demographics
NPI:1356469035
Name:MERRITT CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:MERRITT CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COTTON
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-744-3800
Mailing Address - Street 1:2005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3019
Mailing Address - Country:US
Mailing Address - Phone:806-744-3800
Mailing Address - Fax:806-744-4210
Practice Address - Street 1:2005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3019
Practice Address - Country:US
Practice Address - Phone:806-744-3800
Practice Address - Fax:806-744-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186014OtherHMO BLUE
TX5630614OtherAETNA
TX0199790OtherDEPT OF LABOR & INDUSTRIE
TX8F3860OtherBCBS
TX5630614OtherAETNA
TX0199790OtherDEPT OF LABOR & INDUSTRIE
TX186014OtherHMO BLUE
TX=========OtherHEALTHSMART
TX=========OtherFIRST HEALTH
TX=========OtherCORVEL
TX=========OtherPHCS
TX=========OtherFIRST HEALTH